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Accommodation Policy and Process

Please refer to the Faculty of Medicine bylaws, section 9.3: Faculty Council Appeals Committee. 

Policy And Procedures On Appointing a Program Director

PURPOSE

To outline the principles and process for the appointment of a new Program Director to oversee residency and AFC programs.

The CanRAC General Standards of Accreditation for Institutions with Residency Programs and the General Standards of Accreditation for Areas of Focused Competence Programs require that each accredited postgraduate program has a Program Director who is responsible for the overall conduct of the program. This policy is written in accordance with the Royal College Policy on Appointing a Program Director (Appendix 1) and clarifies acceptable processes to appoint a qualified program director, including responsibilities of the PGME institution on their appointments.

PRINCIPLES

• It is recognized that Residency Program Directors require leadership ability, strong communication and interpersonal skills, effective advocacy skills, and a commitment to the practice of lifelong learning. They must also have a working knowledge of the principles of adult learning and the educational objectives of the relevant discipline.
• Appointed program directors must also have appropriate qualifications to design, coordinate and deliver training that meets the conjoint accreditation standards to prepare residents for success at the certification examination and facilitate graduate competence for safe independent practice (PGME – Program Director Job Description).
• Ensuring appropriate qualifications of a Program Director is a shared responsibility. The Program Director reports to both the Chair of the Department (and Division Head where appropriate) as well as the Vice Dean, Postgraduate Medical Education (PGME). The Department Chair and Postgraduate Dean are jointly responsible for the recruitment and selection of the Program Director, ensuring that the Program Director has sufficient qualifications, time, and support to administer the residency program, and con ducting appropriate performance evaluations and management strategies.
• The protected FTE and administrative support for Program Directors will be determined and agreed upon based on the PGME guidelines for the number of residents for which the respective Program Director is responsible (Appendix 2).
• The Royal College and CFPC confirms the appointment to ensure that all relevant standards are met.

PROCEDURE

1. There is a collaborative process between the academic lead of the discipline (Department Chair) and the Postgraduate Dean for the appointment of each Program Director. The following procedures apply:
   1. The Department Chair (or delegate) will notify the Vice Dean, PGME when a change in Program Director is being considered and indicate the rationale for the change
   2. The appointment of a Program Director will be the conjoint responsibility of the Department Chair (or delegate) and the Vice Dean, PGME (or delegate).
      1. In small training programs, the academic lead may identify a candidate and will consult with the Vice Dean, PGME, regarding the faculty member’s suitability.
      2. Where a Selection Committee is convened, standard procedures should be conducted:
         1. Advertising the position
         2. Shortlisting and interviewing applicants
         3. Selection Committee members must have completed training to mitigate unconscious bias within the 2 years prior to the interview proceedings (available on Brightspace)
         4. Selection Committee members will adhere to equity, diversity and inclusion (EDI) principles in line with 91��Ʒ���ϳԹ�’s Commitment on EDI.
         5. Membership on the selection committee should include representation from: resident/trainee, administrative staff, and program committee member. The Department Chair and PGME Dean (or their delegates) will co-chair the selections committee.
      3. Final appointment must be approved by both the Department Chair and the Postgraduate Dean.
      4. The usual term of a Program Director is 5 years (renewable once). In exceptional circumstances, and with collaboration between the Department Chair and the Postgraduate Dean, this may be extended temporarily.
2. Program Directors should not have a real or perceived conflict of interest with the program of which they are the director due to other roles they may play within the institution, such as the chair of the academic or head of the clinical department or division. In such cases where there is a real or perceived conflict of interest, that conflict must be declared to and reviewed by the PGME Vice Dean and Senior Vice Dean to be managed appropriately.
3. Upon appointment and confirmation to the role for the first time, Program Directors must undertake the requirements of the governing bodies.
   1. PGME requirements:
      1. Complete available 91��Ʒ���ϳԹ� PGME training modules within 12 months of their appointment.
      2. Meet with both the Vice Dean and Assistant Dean, PGME within 6-8 weeks of the appointment (facilitated by the PGME office).
      3. Assignment of a Program Director mentor/coach if one is not self-identified.
      4. Complete a Pulse 360 evaluation after 12 months of appointment.
   2. Royal College requirements:
      1. Must complete accepted Royal College training (e.g., New Program Director Workshop) within 12 months of their appointment to the position of program director; and/or
      2. One-on-one coaching with a Royal College Fellow/Subspecialist Affiliate who has current or recent experience as a program director of a Royal College-accredited program. Coaching must commence within three months of the appointment to the position of program director and continue for at least one year.
   3. CFPC requirements:
      1. Must have current CCFP licensure and being in good standing with CFPC.
4. There must be a single designated Program Director who is accountable for the residency program. Co-director models and/or the appointment of Associate or Assistant Program Directors are acceptable; however, one single Program Director must be identified as being responsible and accountable for the residency program and who acts as the main interlocutor with the PGME office and the relevant accreditation college.
   1. For a Program Director who undertakes a leave of absence from their role, the PGME office must be notified by the academic lead as to who the acting Program Director will be and the timeframe for that individual to be in the role.
5. Programs must have continuous oversight by a designated Program Director. Should the Program Director position become vacant at any time, the position may be filled on an interim basis.
   1. For a maximum of 12 consecutive months, an interim Program Director who does not meet the qualifications may be appointed.
   2. In a Royal College program, after the 12-month interim directorship, the Program Director position should be filled by someone who meets the above requirements for at least three years before another interim Program Director will be accepted by the Royal College.
6. The appointment of a Program Director who does not meet the requirements outlined above has implications for the program’s accreditation status.
7. PGME has responsibility for the training and faculty development of the Program Director.

ROLES AND RESPONSIBILITIES WITH REGARD TO PROGRAM DIRECTORS

Academic Department Chairs are responsible for:

1. Adequate protected time relative to the size and circumstances of the residency program (Appendix 2).
2. Adequate protected time for continuing professional development, especially for mandatory requirements of the Royal College.
3. Adequate administrative support relative to the size and circumstances of the residency program (Appendix 2).
4. Annual review of performance as part of the performance appraisal process, with input from the Vice Dean, PGME (or delegate).
5. Additional faculty or administrative positions as required depending on the size of the residency program, CBD functionality and/or the number and distribution of educational sites.
6. Advocacy for appropriately located and equipped office space in proximity to resident and administrative needs.
7. Additional resources requiring departmental/divisional/faculty support.

Academic Institution (PGME) is responsible for: 

1. Ensuring programs are overseen by appropriately qualified Program Directors, and, through the postgraduate dean/senior education officer in collaboration with the academic lead of the discipline, are responsible for, and have authority for the recruitment and selection of program directors with acceptable qualifications.
2. Ensuring programs have continuous oversight with no gaps in the Program Director position, and that the requirements in section 5 of the policy are followed when Program Directors are appointed on an interim basis.
3. Supporting newly-appointed Program Directors within their institution to undertake the training and/or coaching required, including availability of resources, forms, modules and faculty development.
4. Providing a Leadership 360 multisource feedback review at the end of the first year as Program Director with face-to-face feedback about performance.
   1. Providing faculty development or coaching to address any issues identified.
   2. Repeat PULSE 360 Leadership survey every 2-3 years through the entire term of the Program Director.
5. Providing information to the Colleges about the credentials of each Program Director and for informing the Colleges within two weeks when a new Program Director is appointed.
6. Ensuring the information submitted for institution and program accreditation-related activities is accurate and complete.
7. In consultation with the Department Chair (and Division Head where appropriate), a Program Director may be replaced at the request of the Vice Dean, PGME.

Program directors are responsible for: 

1. Completing the Program Director training and/or coaching.
2. Fulfilling the responsibilities of a Program Director as set out in the general and relevant specialty-specific standards of accreditation, including, but not limited to:
   1. Ensuring the design and delivery of accredited programs align with the general and specialty-specific standards of accreditation;
   2. Overseeing assessment decisions regarding resident progress through the program, including identification of residents who are not progressing as expected, residents who are examination eligible, and residents who have met the requirements for certification;
   3. Providing the required summative documents for exam eligibility and for each resident who has successfully completed the residency program; and
   4. Participating in the relevant discipline Specialty Committee, according to the role description for a non-voting member.
3. Participate in PGME Committees including mandatory quarterly attendance of PGEC as a general member and monthly attendance at PGEC Executive according to designation procedures.
   1. Program Directors have the opportunity to sit on various PGME subcommittees depending on interest.

Policy for the Assessment of the AFC Trainees & Clinical Fellows

Effective date: Immediately following approval from the Executive Committee of University Senate. 

INTRODUCTION

1. This policy of The Faculty of Medicine ensures that there is a fair and transparent assessment system for postgraduate trainees enrolled in Clinical Fellowship Programs or Areas of Focused Competence (AFC) diploma programs at the University of Ottawa Faculty of Medicine.
2. This policy has been developed to be compliant with the following University of Ottawa academic policy and policies of the following medical organizations:
   1. The University of Ottawa Faculty of Medicine Professionalism Policy;
   2. The College of Physicians and Surgeons of Ontario (CPSO) Policy on Professional Responsibilities in Postgraduate Medical Education;
   3. The Canadian Medical Association Code of Ethics (CMA); and
   4. Council of Ontario Universities (COU/COFM).

PURPOSE

1. The purpose of this policy, the Policy and Procedure for the Assessment of AFC Trainees and Clinical Fellows (“policy”), is to outline the processes governing assessment for all postgraduate trainees enrolled in AFC or clinical fellowship programs at the University of Ottawa, Faculty of Medicine.  

SCOPE

1. This policy sets out the procedures for the assessment of AFC trainees and fellows. All trainees are responsible for becoming familiar with this policy.
2. In this policy, the word “must” is used to denote something that is required, and the word “should” is used to denote something that is highly recommended.

DEFINITIONS

For the purposes of this Policy,

1. “AFC” means Areas of Focused Competence and is a post-residency diploma program that provides additional training and is accredited by the Royal College of Physicians and Surgeons of Canada.
2. “AFCPC” means the AFC Program Committee which is the committee that assists the AFC Program Director in the planning, organization, and supervision of the AFC training program and includes representation from the trainees in the program.
3. “AFC Trainee” means a physician registered in an AFC Diploma training program, accredited by the RCPSC, and who is registered with the Postgraduate Medical Education Office of the Faculty of Medicine of the University.
4. “Assessment” is the process of gathering and analyzing information in order to measure a trainee’s competence or performance and compare it to defined criteria.
5. “CFC” is the Clinical Fellowship Committee which is the Faculty Postgraduate Medical Education (PGME) committee that coordinates Faculty of Medicine Post-Residency Fellowship Education in all recognized programs and is chaired by the Vice-Dean (PGME).
6. “Competence Committee” as defined by the Royal College of Physicians and Surgeons of Canada (RCPSC) is a subcommittee of the Fellowship Program Committee (FPC) or AFCPC and is the committee that makes recommendations about promotion and needed academic support to the FPC/AFCPC and the related Program Director. Recommendations are made using highly integrative data from multiple observations and other sources of data, as well as feedback from clinical practice. All recommendations must be reviewed and approved by the FPC/AFCPC.
7. “Designated assessment tools” means assessment tools approved by the Program Committee of each program for inclusion in the assessment plan of trainees which are appropriately tailored to the specialty level of training.
8. “Educational experience” refers to the activity or setting in which the trainees have the experiences that allows them to achieve pre-defined goals and objectives and/or milestones and competencies. Examples of words commonly used to describe discrete clinical training experiences include rotation, longitudinal clinics, call, etc.
9. “Fellow” means a postgraduate medical education trainee undertaking post-certification training to acquire specialized expertise not normally obtained during residency training. Fellowship training takes place outside the specialty or subspecialty training requirements of the Royal College of Physicians and Surgeons of Canada (RCPSC) or College of Family Physicians Canada (CFPC) and cannot be credited toward national certification requirements. Fellowship programs include trainees registered in Areas of Focused Competence.
10. “Formative assessment” refers to assessments done to monitor a trainee’s progress and to give ongoing feedback.
11. “FPC” means the Fellowship Program Committee and it is the committee that assists the Fellowship Program Director in the planning, organization, supervision and assessment of the training program and includes representation from the fellows in the program.  
12. “PEAP” means Pre-Entry Assessment Program. The PEAP is an assessment process that evaluates an International Medical Graduate to determine whether they can function at the appointed level of training. Successful completion of the PEAP provides an assessment of the candidate’s general knowledge and competency in the specialty in which they are certified and if successfully completed, can be counted towards fulfillment of the AFC diploma or fellowship.
13. “PGEC” means the Faculty Postgraduate Medical Education Committee and is the committee responsible for the development and review of all aspects of postgraduate medical education within the Faculty of Medicine and is chaired by the Vice-Dean (PGME).
14. “Program or Fellowship Director” is the faculty member responsible for the overall conduct of the clinical fellowship or AFC training program and reports to the Chair of the University department concerned and to the Vice-Dean (PGME).
15. “RCPSC” means the Royal College of Physicians and Surgeons of Canada
16. “Senior physician leader” means the head or chief of the medical staff, regardless of the position title, appointed by the health organization (for example: hospitals, medical clinics, primary care agencies, health regions, long-term care organizations, public health agencies) as the senior leader accountable to the board of directors or highest governing body of the health care organization for the quality of patient care at the health organization or for matters in relation to public health.
17. “Scoring rubrics” are the scoring guides used to assess performance for individual assessments.
18. “Summative assessment” refers to a formal written summary of a trainee’s performance against established expectations which is carried out at specified intervals within each program and across assessment plans.
19. “Supervisor” means an individual who has taken on the responsibility for their respective training programs to guide, observe and assess the educational activities of trainees.
20. “VISA trainee” means an individual who is training at the University of Ottawa without Canadian legal status (i.e. is neither a Canadian citizen nor permanent resident of Canada) and is training under a work permit.

STANDARDS OF ASSESSMENT

1. It is the responsibility of the CFC to maintain standards for the assessment, promotion, remediation, probation, suspension and dismissal of trainees in clinical fellowship and AFC programs.  
   1. Assessment during the PEAP must adhere to the guidelines set out by PGME for this process.  Formal acceptance into the program will occur after successful completion of the PEAP.  Thereafter, this Policy will apply.
   2. The CFC will review the assessment process of each clinical fellowship and AFC programs on a regular basis to ensure that assessment processes and practices are consistent with this Policy, and the minimum standards set by the related professional organizations, including the CPSO and the RCPSC as appropriate.  The CFC will monitor the performance of programs either directly or through the relevant subcommittee of the CFC.

STRUCTURE

1. Every program must have an Assessment Framework that includes designated assessment tools and scoring rubrics tailored to the AFC or clinical fellowship training.
2. The purpose of the Assessment Framework is as follows:
   1. To provide a framework for the assessment of the trainee’s knowledge, skills, attitudes and competencies by the supervisor;
   2. To facilitate feedback to the trainee by a supervisor or the Fellowship/AFC Program Director;
   3. To serve as a record of the performance and progress of the trainee for the program;
   4. To enable the Fellowship/AFC Program Director to assist supervisors in ongoing supervision of the trainee;
   5. To establish a basis for confirmation of progress, identification of needs, evidence for promotion, remediation and probation.

ASSESSMENT & FEEDBACK

3. During their AFC training or clinical fellowship, trainees will receive fair, timely, equitable and unbiased formative and summative assessments and feedback on an ongoing basis. The principles governing assessment are as follows:
   1. The assessment process must be tied to educational objectives.
   2. Goals and objectives must be assessed with a range of assessment tools.
   3. Goals and objectives must be made available to trainees and faculty at the beginning of each rotation or educational experience to guide trainee in learning and assessment strategies. The goals and objectives should be reviewed by the trainee.
   4. Assessment and feedback is the joint responsibility of both the trainee and the program.  When written feedback is completed, trainees should read written feedback within 14 days of being notified that it has been completed.
   5. All trainees must receive a written summative assessment at least quarterly.  The summative assessment must outline the progress that has been made by a trainee in addressing any areas of concern that have been identified.
      1. Where in-training evaluation reports (ITERs) are used as summative assessments, ITERs should be completed within 14 days of the completion of the rotation/educational experience.
      2. There should be documented, mid-rotation, formative feedback when the rotation is two blocks or longer.
      3. In situations where trainees are ‘on trajectory’, the Fellowship/AFC Program Director or delegate must discuss summative assessments with the trainee at least quarterly.  This discussion should occur face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime, Skype, Zoom or Teams.
      4. In situations where trainees are ‘off trajectory’, the Fellowship/AFC Program Director or delegate must discuss the summative assessment with the trainee.  This discussion should occur within 14 days of the completion of the ITER or summative assessment and must also be given face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime, Skype, Zoom or Teams.
   6. There must be regular, verbal informal feedback provided to trainees as well as formal feedback and assessment as required by this policy.
   7. Trainees must be informed of performance deficiencies in a timely manner so that they can have adequate opportunity to remedy them prior to the end of the educational experience.  The feedback must be documented in the trainee’s file.
   8. Both the supervising physician or Fellowship/AFC Program Director or delegate and the trainee should sign or validate the summative assessment within 14 days. The trainee’s signature/validation does not necessarily imply that they agree with the summative assessment; rather the signature/validation indicates that it has been seen by the trainee.  Failure of the trainee to sign/validate the form does not invalidate the summative assessment or the discussion.  
4. The AFC or Fellowship Program Committee makes decisions regarding the successful completion of an assessment period, educational experience, rotation, and academic year for the program.
5. Decisions regarding completion of program, remediation, probation, suspension or dismissal must be ratified by the Vice-Dean (PGME) or delegate.  If any of these decisions are made by the PGME Professionalism Subcommittee, ratification by the Vice-Dean (PGME), or delegate, is not required.  Decisions by the Vice-Dean (PGME) or delegate, PGME Professionalism Subcommittee regarding remediation, probation must be ratified by the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place.   In cases of suspension or dismissal, ratification by the senior physician leader is not required, however, the PGME office will notify the senior physician leader of the suspension or dismissal. 

TRAINEE WELLNESS

6. All trainees who are put on a remediation measure should be referred for a wellness assessment (e.g. Faculty Wellness Program, OMA, EAP, PHP) as part of the support provided during this process. The Fellowship/AFC Program Director or delegate should review the process of referral, including the confidential nature of the referral with the trainee.

PROGRAM COMPLETION 

1. For Fellowships, the Program Committee (FPC) will determine the rotation or educational experience requirements for the program. The rotation or educational experiences requirements may be amended from time to time and must be communicated to the trainees.
2. For AFC Programs, the Program Committee (AFCPC) will determine the rotation or educational experience requirement for the program based on the AFC standards.  Rotation or educational experiences requirements may be amended from time to time and must be communicated to the trainees.
3. Trainees will complete the fellowship when all requirements have been met. This determination shall be made by the FPC/AFCPC or delegate.
4. Where the academic performance of a trainee results in assessment of unsatisfactory performance, the trainee’s training will be addressed in accordance with the options for unsatisfactory performance as outlined below.

UNSATISFACTORY PERFORMANCE

Unsatisfactory performance may be identified when it is determined that the trainee did not meet the defined educational objectives. 

1. Reasons why a trainee’s performance may be deemed unsatisfactory include:
   1. a summative assessment or a decision by the FPC/AFCPC demonstrates that the trainee has not met the required objectives or competencies;
   2. a trainee has not satisfied the standards of professionalism as per the Faculty’s Professionalism Policy (Policy on Professionalism - FA | Faculty of Medicine (uottawa.ca)  and the level of the professionalism breach is determined to be at a level 2 or 3;
   3. a trainee is in breach of the policies of the health organization where the trainee’s rotation or training experience is taking place;
   4. the trainee has been absent without receiving appropriate approval from their Fellowship/AFC Program Director, as per the PGME Leave of Absence Policy.
   5. the Program Director and FPC/AFCPC determines that the trainee has not satisfactorily completed a rotation or educational experience.
   6. an unsatisfactory rotation or educational experience can be identified using any of the following language (as defined by individual Program standards and outlined on Assessments): “marginal”, “borderline”, “inconsistently” or “partially meets expectations for level of training”, “below expectations”, “unsatisfactory”, “does not meet expectations for level of training”, “off trajectory”, or any other language explicitly defined by the program to denote unsatisfactory performance.
   7. any serious patient safety issue/concern may be defined as a performance deficiency and lead to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to remediation, probation or dismissal decision. This must be documented in the trainee’s file.
   8. uncorrected performance deficiencies on any type of assessment may contribute to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to remediation, probation, suspension or dismissal decision.
2. The determination of whether a trainee can or cannot be assessed should be made on an individual, case-by-case basis. The assessment should take into account factors such as the trainee’s individual performance and experience, the total length of the training experience, and the nature of the educational experience being missed.
3. Where there has been an unsatisfactory or incomplete performance, the program committee must decide what action is required and whether to recommend that the trainee be required to enter one of the following remedial periods listed below.  In programs with a competency committee, this decision would be guided by the committee’s recommendations.  In cases where the trainee has been referred to the Professionalism Subcommittee for professionalism concerns as per the Faculty of Medicine Professionalism Policy, the Professionalism Subcommittee may decide that the trainee be required to enter one of the following remedial measures listed below.  A decision of the Professionalism Subcommittee does not require ratification by the Vice-Dean (PGME) or delegate.
4. Where concerns have been raised regarding a trainee’s performance, the Fellowship/AFC Program Director, or delegate, must review the concerns with the trainee.  The purpose of this communication is to ensure a full assessment of the issues as well as disclosure of the evidence and rationale for the concerns.
5. The program committee will review all relevant supporting documentation prior to making a decision regarding a trainee’s unsatisfactory or incomplete performance.  The trainee must be provided with the opportunity to address the concerns with the FPC/AFCPC; this communication may be verbal or written.

REMEDIAL MEASURES

1. In the event that a trainee’s performance has been deemed unsatisfactory, the trainee may be required to undergo the following:
   1. remediation
   2. probation
2. This remedial measure is intended to deal with problems which are not expected to be readily corrected in the normal course of the fellowship program.

REMEDIATION

1. Remediation is a formal program of individualized training during which the trainee is expected to correct identified weaknesses and/or deficiencies where it is anticipated that those weaknesses can be successfully addressed to allow the trainee to meet training requirements. Remediation shall normally be for a period of no more than two blocks (approximately equivalent to 2 months).     
2. Recommendations for remediation must be brought to the Program’s training committee (FPC/AFCPC) by the Program Director or competency committee. A decision regarding remediation will be taken by the FPC/AFCPC. The decision must be ratified by the Vice-Dean (PGME) or delegate.
3. A remediation plan must be completed by the Program which must include the following:
   1. details regarding the reasons for remediation;
   2. the specific areas of deficiency where the trainee is off their educational trajectory;
   3. the objectives during the formal remediation and other outcomes that need to be met for the expected educational trajectory at the trainee’s stage of training;
   4. the methods of assessment during the remediation;
   5. the duration of the remedial period;
   6. the possible outcomes of the remediation; and
4. The remediation plan must be ratified by the Vice-Dean (PGME) or delegate prior to its implementation.
5. At the end of a remediation period, the FPC/AFCPC, or delegate, must complete a Final Remediation Outcome form. The Fellowship/AFC Program Director will inform the trainee in person and in writing as to the results of the remediation and the recommendation(s) of the FPC/AFCPC. The outcome of the remediation must be ratified by the Vice-Dean (PGME) or delegate.
6. A trainee may receive credit for training which is successfully completed during a period of remediation as decided by the FPC/AFCPC.
7. If the trainee’s performance in remediation is unsatisfactory, they may be placed on an unpaid interruption in training.  Where the remediation is unsuccessful, the FPC/AFCPC may recommend to the Vice-Dean (PGME) or delegate that the trainee enter a period of probation.
8. A trainee may have a maximum of two (2) remedial periods (including probation as one of the remedial periods) at any time during a fellowship or AFC training program.  Dismissal may be considered as an outcome of a second remedial period; these remedial periods do not need to be consecutive.

PROBATION

1. A trainee will be placed on probation in circumstances where the trainee is expected to correct identified serious problems including but not limited to, academic, professionalism or patient safety issues that are assessed to jeopardize successful completion of the training program. Probation shall not exceed 2 blocks/months.
2. Recommendations for probation must be brought to the FPC/AFCPC by the Program Director or competency committee. A decision regarding probation will be taken by the FPC/AFCPC. The decision must be ratified by the Vice-Dean (PGME) or delegate     .
3. In cases where it has been determined that a trainee has acted unprofessionally, probation will be managed in accordance with Faculty of Medicine Professionalism Policy.
4. A probation plan must be completed by the Program which must include the following:
   1. details regarding the reasons for probation;
   2. the specific areas of deficiency where the trainee is off their educational trajectory;
   3. the objectives during the probationary period that need to be met for the expected educational trajectory at the trainee’s stage of training;
   4. the methods of assessment during the probationary period;
   5. the duration of the probationary period;
   6. the possible outcomes of the probation;
5. The probation plan must be ratified by the Vice-Dean (PGME) or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place prior to its implementation.
6. At the end of a probation period, the FPC/AFCPC, or delegate, must complete a Final Probation Outcome form. The Fellowship/AFC Program Director will inform the trainee in person and in writing as to the results of the probationary period and the recommendation(s) of the program committee. The outcome of the probation must be ratified by the Vice-Dean (PGME)  or delegate.
7. A trainee may receive credit for training which is successfully completed during a period of probation as decided by the FPC/AFCPC
8. Where the probation is unsuccessful, the FPC/AFCPC may recommend to the Vice-Dean (PGME) or delegate that the trainee be dismissed from the program.    

SUSPENSION

1. Suspension is a temporary interruption of a trainee’s participation in the clinical fellowship or AFC training program and includes interruption of clinical and educational activities.
2. The conduct of trainees is governed by the policies of professional bodies such as the CPSO and by the Professionalism Policy of the Faculty of Medicine, University of Ottawa. Violation of any of these standards and policies may constitute improper conduct warranting suspension. A single serious incident of unprofessionalism or a series of incidents of unprofessionalism may justify suspension.  
3. A supervisor may immediately remove a trainee from clinical or non-clinical responsibilities if the trainee’s conduct is deemed to pose a safety risk to patients, staff, students, or the public that uses the setting.  The supervisor must notify the Program Director as soon as possible. Only a Fellowship/AFC Program Director, Vice-Dean (PGME) or delegate, or the PGME Professionalism Subcommittee may formally suspend a trainee.  If the Program Director suspends a trainee, the suspension must be ratified by the Vice-Dean (PGME) or delegate.          
4. The Vice-Dean (PGME) or delegate must notify the trainee in writing of the suspension and the notification must include the reasons for and duration of the suspension.  During the suspension period, payment to the trainee will be in accordance with the fellow/AFC trainee contract pending review by the Vice-Dean (PGME) or delegate, and/or the Professionalism Subcommittee.    
5. The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is suspended from clinical duties pending investigation and adjudication of the issue leading to suspension.  

DISMISSAL FROM THE PROGRAM

1. A trainee may be dismissed from the program if any of the following conditions exist:
   1. a trainee fails a probation period;
   2. a trainee does not maintain the standards of the profession as described in the Faculty’s Professionalism Policy;
   3. a trainee meets the criteria of the Regulated Health Professions Act of Ontario for clinical incompetence or incapacitation; or,
   4. lack of a training site and/or faculty available to provide training  because of concerns for professionalism or patient safety.
2. A decision regarding dismissal of a trainee will only be taken by the program’s FPC/AFCPC on the recommendation of the Program Director or by the Professionalism Subcommittee. When the decision has been made by the program’s FPC/AFCPC, the decision must be ratified by the Vice-Dean (PGME) or delegate.  Decisions of the Professionalism Subcommittee do not require Vice-Dean (PGME) ratification.
3. The trainee must be informed of the decision in writing.  The notification must include the reason(s) for dismissal.
4. The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is dismissed from the program.   

APPEALS 

1. A trainee has the right to appeal a final decision regarding remediation, probation, suspension or dismissal as ratified by the Vice-Dean (PGME) or delegate or by the Professionalism Subcommittee to the Faculty Council Appeals Committee. A decision regarding failure of a single training experience for which the consequences are limited to repeating the required training is not eligible for appeal.   
2. An appeal is not an opportunity for the trainee to repeat the information provided previously during the process leading up to the final decision. The trainee’s right to an appeal is not automatic and an appeal will only be considered by the Faculty Council Appeals Committee if it meets the following requirements:
   1. The appeal to the Faculty Council Appeals Committee must be made in writing and within 10 business days after the date of the final decision that is the subject of the appeal; and
   2. The appeal must include the reasons for the appeal, the reasons why the appeal should be granted, the arguments in support of the appeal and the outcome sought; and
   3. The trainee must demonstrate that,
   4. there has been a fundamental procedural error in the making of the final decision and that such error has caused or will cause actual prejudice to the person seeking the appeal (for example: policies and procedures were not followed, or the decision-maker did not consider evidence relevant to the final decision); or
   5. there are new facts relevant to the final decision that were not available and could not have been provided during the process leading up to the final decision.
3. The following is a list of some additional examples of situations where an appeal would not meet the requirements of paragraph 14.2:
   1. The appeal asks for review of a consequence or measure that has not yet been finally decided or approved.
   2. The appeal repeats arguments previously made during the process leading up to the final decision and does not provide any new information relevant to the final decision.
   3. The appeal is based only on a disagreement with a finding of fact, including findings made about the credibility of witnesses.
   4. The appeal raises new arguments that were not made previously, but the trainee could have made these arguments during the process leading to the final decision.
   5. The appeal amounts to a mere speculation, or a bald statement of a procedural error causing prejudice and does not provide detailed and convincing information to establish the error and to establish a link between the error and actual prejudice or a reasonable expectation of prejudice to the trainee.
4. The trainee should consult the Faculty Council Appeals Committee procedures (section 9.3 of the Faculty of Medicine bylaws Policies and Bylaws | Faculty of Medicine (uottawa.ca) concerning the preparation and submission of an appeal and the applicable deadlines.
5. While a trainee may appeal a final decision regarding probation as ratified by the Vice-Dean (PGME) or delegate, or a Professionalism Subcommittee decision to the Faculty Council Appeals Committee, the trainee is required to undertake the period of probation pending the results of the Appeal.  Failure to do so will result in the trainee being placed on leave from training for the duration of the appeal process.  If the appeal is upheld for the trainee, the period of training will receive credit to the extent possible.
6. While a trainee may appeal a final decision regarding suspension or dismissal, as ratified by the Vice-Dean (PGME) or delegate, or a Professionalism Subcommittee decision to the Faculty Council Appeals Committee, the trainee will remain on unpaid leave  from training pending the results of the Appeal.
7. A trainee may appeal the decision of the Faculty Council Appeals Committee to the University Senate Appeals Committee.  To do this, the trainee should consult the Office of the Secretary-General concerning the preparation and submission of such an appeal and the applicable deadlines.

NOTIFICATION

1. When a trainee is assessed by the AFCPC near the end of the training program as having met the prerequisites for certification by the RCPSC, the Vice-Dean (PGME) will notify the RCPSC of this through a Confirmation of Competencies Acquired (CCA), in the required manner. At the request of the AFC Program Director, the PGME office will issue a certificate of completion.
2. When a trainee is assessed by the FPC at the end of the training program as having met the training objectives of the Clinical Fellowship, at the request of the Fellowship Program Director, the PGME office will issue a certificate of completion.

 
GENERAL

1. This policy replaces any previous versions of the policies and procedures on PGME evaluations.

 
REVIEW

1. This policy will be reviewed 1 year after adoption and every 3 years subsequently.

Policy for the Assessment of Postgraduate Residents

Effective date: Immediately following approval from the Executive Committee of University Senate. 

1. INTRODUCTION

1.1 This policy of The Faculty of Medicine ensures that there is a fair and transparent assessment system for postgraduate residents enrolled in postgraduate residency training programs at the University of Ottawa Faculty of Medicine.   This policy does not pertain to Clinical or research Fellows or trainees in Area of Focused Competency (AFC) diploma programs (see Policy and Procedure for the Assessment of AFC Trainees and Clinical Fellows).

1.2. This policy has been developed to be in compliance with the accreditation standards of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC).  This policy is also designed to be consistent with the following University of Ottawa academic policies, and policies of the following medical organizations:

a) The University of Ottawa Faculty of Medicine Professionalism Policy;

b) The College of Physicians and Surgeons of Ontario (CPSO) Policy on Professional Responsibilities in Postgraduate Medical Education;

c)The Canadian Medical Association Code of Ethics (CMA);

d) Council of Ontario Universities (COU/COFM)

    
2. PURPOSE

2.1 The purpose of this policy, the Policy and Procedure for the Assessment of Postgraduate Residents (“policy”), is to outline the processes governing assessment for all postgraduate residents enrolled in accredited residency programs at the University of Ottawa Faculty of Medicine.  

3. SCOPE

3.1 This policy sets out the procedures for the assessment of residents. Residents and Residency Program Committees are responsible for becoming familiar with this policy.

3.2 This policy is designed to apply to both time based and competency based educational experiences and programs.

3.3 This policy does not apply to residents during the Assessment Verification Period (AVP), AVP Extension/remediation period or Pre-Entry Assessment Program (PEAP). For these residents, the relevant CPSO policies apply.

3.4 In this policy, the word “must” is used to denote something that is required, and the word “should” is used to denote something that is highly recommended.

4. DEFINITIONS

For the purposes of this Policy,

4.1 “Assessment” is the process of gathering and analyzing information to measure a resident’s competence or performance and compare it to defined criteria.

4.2 “AVP” means Assessment Verification Period.  The AVP is a period of assessment to determine if an International Medical Graduate (IMG) can function at their appointed level of training prior to full acceptance into the residency program to which they have been accepted. Successful completion is a requirement to obtain a postgraduate medical education certificate of registration (educational license) from the College of Physicians and Surgeons of Ontario. A successful AVP should be credited towards residency training time. An extension of an AVP, which must be accompanied by a remediation, may or may not be credited towards residency training. 

4.3 “Competence Committee” as defined by the RCPSC is a subcommittee of the Residency Program Committee (RPC) and is the committee responsible for recommendations regarding resident promotion and/or needed academic support to the RPC and the program director. Recommendations are made using highly integrative data from multiple observations and other sources of data, as well as feedback from clinical practice. All recommendations must be reviewed and approved by the RPC and the Program Director.

4.4 “Designated assessment tools” means assessment tools approved by the RPC of each program for inclusion in the assessment plan of residents which are appropriately tailored to the specialty, level or stage of training, and the national training standards.  

4.5 “Educational experience” refers to the activity or setting in which the residents have the experiences that allows them to achieve pre-defined goals and objectives and/or EPAs, milestones and competencies. Examples of words commonly used to describe discrete clinical training experiences include rotation, longitudinal clinics, call, etc.

4.6 “EPA” means entrustable professional activity and is an authentic task of a discipline.

4.7 “Formative assessment” refers to assessments done to monitor a resident’s progress and to provide ongoing feedback.

4.8 “IMG” means International Medical Graduate and is an individual who has graduated from a non-Liaison Committee on Medical Education/Committee on Accreditation of Canadian Medical Schools (non-LCME/CACMS) accredited medical school, who is either a Canadian citizen or a Canadian permanent resident and who meets the criteria of an IMG as defined by the CPSO.

4.9 “Milestone” is an observable marker of an individual’s ability along a developmental continuum.

4.10 “PGEC” means the Faculty Postgraduate Medical Education Committee and is the committee responsible for the development, oversight and review of all aspects of postgraduate medical education within the Faculty of Medicine and is chaired by the Vice-Dean, PGME.

4.11 “PEAP” means Pre-Entry Assessment Program. The PEAP is an assessment process that evaluates a VISA resident to determine whether they can function at the appointed level of training.  Successful completion of the VISA residency PEAP determines eligibility to enter residency training and therefore is not recorded as part of the residency training program.  

4.12 “Program Director” is the Faculty member responsible for the overall conduct of the residency program in a discipline and reports to the Chair of the University department concerned and to the Vice-Dean, PGME.

4.13 “Residency Program” means the RCPSC or CFPC postgraduate residency training program.

4.14 “RPC” means the Residency Program Committee and it is the committee that assists the Residency Program Director in the planning, organization, and supervision of the residency training program and includes representation from the residents in the program and other major stakeholders in the residency training program.

4.15 “Resident” means a physician registered in a residency training program accredited by the RCPSC or the CFPC and who is registered in the Postgraduate Medical Education Office at the Faculty of Medicine of the University.

4.16 “Senior physician leader” means the head or chief of the medical staff, regardless of the position title, appointed by the health organization (for example: hospitals, medical clinics, primary care agencies, health regions, long-term care organizations, public health agencies) as the senior leader accountable to the board of directors or highest governing body of the health care organization for the quality of patient care at the health organization or for matters in relation to public health. 

4.17 “Scoring rubrics” are the scoring guides used to assess performance for individual assessments.

4.18 “Stages of Training” means the four developmental stages in RCPSC Competency Based Medical Education (CBME) programs. They are: Transition to Discipline, Foundation of Discipline, Core of Discipline, and Transition to Practice. Each stage has defined EPAs and milestones for learning and assessment.

4.19 “Summative assessment” refers to a formal written summary of a resident’s performance against established expectations which is carried out at specified intervals within each program and across assessment plans.

4.20 “Supervisor” means an individual who has taken on the responsibility for their respective training programs to guide, observe and assess the educational activities of residents.

4.21 “Time Based Program” means a program whose structure is based on goals and objectives and time-based educational experiences. 

4.22 “VISA resident” means an individual who has graduated from a non-LCME/CACMS medical school and who is training at the University of Ottawa without Canadian legal status (i.e. training under a VISA), and is neither a Canadian citizen or permanent resident of Canada.

5. STANDARDS OF ASSESSMENT

5.1 It is the responsibility of the PGEC to maintain standards for the assessment, promotion, reclassification, remediation, probation, suspension, extension of training, reintegration and dismissal of residents in all residency programs.  The PGEC will review the assessment process of each residency program on a regular basis as defined by accreditation standards to ensure that assessment processes and practices are consistent with this Policy, and the minimum standards set by the related professional organizations, including the CPSO, CFPC and the Royal College.  The PGEC will monitor the performance of programs either directly or through the relevant subcommittee of the PGEC.

6. PRINCIPLES OF RESIDENT ASSESSMENT

Structure

6.1 Every program must have an Assessment Framework that includes designated assessment tools and scoring rubrics tailored to the specialty and level or stage of training which would meet the national training standards.

6.2 The purpose of the Assessment Framework is as follows:

6.2.1 To provide a framework for the assessment of the resident’s knowledge, skills, attitudes and competencies by the supervisor;

6.2.2 To facilitate feedback to the resident by a supervisor or the Program Director;

6.2.3 To serve as a record of the performance and progress of the resident for the program;

6.2.4 To enable the Program Director to assist supervisors in ongoing supervision of the resident;

6.2.5 To establish a basis for confirmation of progress, identification of needs, evidence for promotion, reassessment/reclassification, extension of training, remediation and probation.

Assessment and feedback

6.3 During their postgraduate training program, residents will receive fair, timely, equitable and unbiased formative and summative assessments and feedback on an ongoing basis. The principles governing assessment are as follows:

6.3.1 The assessment process must be tied to educational objectives, or to EPAs and milestones.

6.3.2 Goals and objectives, EPAs and milestones must be assessed with a range of assessment tools.

6.3.3 Goals and objectives, or EPAs and milestones must be made available to residents and faculty at the beginning of each rotation or educational experience to guide resident learning and assessment strategies. The goals and objectives, or EPAs and milestones, should be reviewed by the resident.

6.3.4 Assessment and feedback is the joint responsibility of both the resident and the program.  When written feedback is completed, residents should read written feedback within 14 days of being notified that it has been completed. 

6.3.5 All residents must receive a written summative assessment at least quarterly.  The summative assessment must outline the progress that has been made by a resident in addressing any areas of concern that have been identified. 

6.3.5.1 Where in-training evaluation reports (ITERs) or in-training assessment reports (ITARs) are used as summative assessments, ITERs/ITARs should be completed within 14 days of the completion of the rotation/educational experience. 

6.3.5.2 In traditional time-based programs, there should be documented, mid-rotation, formative feedback when the rotation is two blocks or longer. 

6.3.5.3 In situations where residents are ‘on trajectory’, the program director or delegate must discuss summative assessments with the resident at least twice per year.  This discussion should occur face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime, Skype, Zoom or Teams.

6.3.5.4 In situations where residents are ‘off trajectory’, the program director or delegate must discuss the summative assessment with the resident.  This discussion should occur within 14 days of the completion of the ITER/ITAR or summative assessment and must also be given face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime, Skype, Zoom or Teams.

6.3.6 In CBD/CBME programs, the Competency Committee must provide the RPC with  summative assessments and recommendations at each transition of stage of training or at minimum semi-annually.    

6.3.7 There must be regular, verbal informal feedback provided to residents as well as formal feedback and assessment as required by this policy.

6.3.8 Residents must be informed of performance deficiencies in a timely manner so that they can have adequate opportunity to remedy them prior to the end of the educational experience.  The feedback must be documented and incorporated into the resident’s file. 

6.3.8 Both the supervising physician or program director or delegate and the resident should sign or validate the summative assessment within 14 days. The resident’s signature/validation does not necessarily imply that they agree with the summative assessment; rather the signature/validation indicates that it has been seen by the resident.  Failure of the resident to sign/validate the form does not invalidate the summative assessment or the discussion.  

6.4 The Residency Program Committee makes decisions regarding the successful completion of an assessment period, educational experience, rotation, stage of training and academic year or of the program as well as completion of any certification requirements where applicable.

6.5 The Competence Committee’s mandate is to review and discuss resident’s performance and progress so as to advise/guide resident learning and growth, modify a resident’s learning plan, make decisions on a resident’s achievement of EPAs, and recommend resident status changes to the Residency Program Committee as per the RCPSC.

6.6 Decisions regarding completion of program, reassessment/reclassification, extension of training, remediation, probation, suspension or dismissal must be ratified by the Vice-Dean, PGME or delegate.  For all decisions made by the PGME Professionalism Subcommittee, ratification by the Vice-Dean of PGME, or delegate, is not required.    As required, the seior physician leader of the health organization where the training experience is taking place may be notified of decisions made by the Vice-Dean, PGME or delegate, PGME Professionalism Subcommittee regarding remediation, probation or reassessment/reclassification, suspension or dismissal.  

Resident Wellness

6.7 All residents who are put on a remediation measure should be referred for a wellness assessment (e.g. Faculty Wellness Program, OMA, PARO, EAP, PHP) as part of the support provided during this process. The program director or delegate should review the process of referral, including the confidential nature of the referral with the resident.

7. PROMOTION

7.1 The Program Director, in consultation with the Residency Program Committee (RPC) for the program, will determine the rotation or educational experience requirements for each year or stage of the program. The rotation or educational experiences requirements may be amended from time to time and must be communicated to the residents.

7.2 Residents will be promoted to the next academic year or stage when all requirements have been met for the level or stage of training. This determination shall be made by the RPC, or delegate.

7.3 The academic promotion of a resident to the next year or next stage of training in any program may be delayed based on any of the following:

7.3.1 pending completion of a remedial or probationary period, or repeat of a failed rotation;

7.3.2 the resident is under suspension; 

7.3.3 the resident has not met the training requirements for that postgraduate year or stage;

7.3.4 the resident has taken an extended leave of absence from training which has resulted in an incomplete educational experience for stage or year of training

7.4 Where the academic promotion of a resident has been delayed because of unsatisfactory performance, the resident’s training will be addressed in accordance with the options for unsatisfactory performance as outlined in section 10 below.

7.5 Residents will not be academically promoted during a period of reassessment/reclassification, remediation, probation or suspension.  

7.6 For residents completing a period of remediation or probation, the Residency Program Committee will review rotations and training experiences completed during the remediation or probation period and will determine whether any of these may receive credit towards RCPSC or CFPC training requirements.  If sufficient credit is awarded, a retroactive promotion may be granted in cases where promotion may have otherwise occurred during the remedial or probation period.

8. REINTEGRATION

8.1 Where a resident has been on an extended leave of absence (>12 months), a period of reintegration to allow for refamiliarization to the learning environment may be warranted prior to resuming formal training.

8.1.1 A resident will not receive credit for training during this period of reintegration

8.1.2 The period of reintegration will generally be two weeks and should not exceed four weeks.

8.1.3 The program must account for any accommodations required for the resident

9. REASSESSMENT/RECLASSIFICATION

9.1 Where a resident has been on an extended leave of absence (>12 months), a period of reassessment/reclassification to assess knowledge, skills and competencies may be warranted prior to resuming formal training.  Residents will be placed at the appropriate level or stage as determined by the RPC, at the completion of the reassessment/reclassification period.  If the resident has lost knowledge, skills or competencies, it may be determined that the resident should be reclassified to a more junior level of training (year or stage), it may be determined that the resident requires a period of remediation, or it may be determined that both are required.

9.2 A resident may receive credit for training which is successfully completed during a period of reassessment/reclassification as decided by the RPC but this will only be determined upon completion of the reassessment/reclassification period.

9.3 The nature and length of the reassessment/reclassification period will be determined by the program’s RPC. The period of reassessment/reclassification will generally be four to eight weeks and should not exceed 12 weeks. The resident must be consulted about the plan and must be provided with a copy of the plan before the reassessment/reclassification period begins. 

9.4 A reassessment/reclassification plan must be completed by the Program which must address the following:

9.4.1 details regarding the reasons for the reassessment/reclassification period;

9.4.2 the specific goals and objective or EPAs and milestones the resident is to be benchmarked to;

9.4.3 the goals and objectives or EPAs and milestones that are to be assessed in determining the resident’s stage or level of training;

9.4.4 the methods of assessment to be used during the reassessment/reclassification;

9.4.5 the duration of the reassessment/reclassification period;

9.4.6 the possible outcomes of the reassessment/reclassification; and

9.4.7 outline the methods by which the final decision will be made around whether the resident has successfully completed a period of reassessment/reclassification and how stage or level will be determined.

9.5 The plan must be drafted by the RPC or delegate and must be ratified by the Vice-Dean PGME or delegate 

10. UNSATISFACTORY AND INCOMPLETE PERFORMANCE

Unsatisfactory or incomplete performance may be identified when it is determined that the resident did not meet the defined educational objectives, EPAs or milestones. 

10.1 Reasons why a resident’s performance may be deemed unsatisfactory include:

10.1.1 a summative assessment or a decision by the Competency Committee demonstrates that the resident has not met the required objectives or competencies;

10.1.2 a resident has not satisfied the standards of professionalism as per the and the level of the professionalism breach is determined to be at a level 2 or 3;

10.1.3 a resident is in breach of the policies of the health organization where the resident’s rotation or training experience is taking place;

10.1.4 the resident has been absent without receiving appropriate approval from their Program Director, as per the processes set out by the PARO-OTH Collective Agreement and/or the PGME Leave of Absence Policy.

10.1.5 the Program Director, RPC, or Competence Committee determines that the resident has not satisfactorily completed a rotation or educational experience. 

10.1.6 an unsatisfactory  rotation or educational experience can be identified using any of the following language (as defined by individual Program standards and outlined on Assessments): “marginal”, “borderline”, “inconsistently” or “partially meets expectations for level of training”, “unsatisfactory”, “does not meet expectations for level of training”, “off trajectory”, or any other language explicitly defined by the program to denote unsatisfactory performance

10.1.7 any serious patient safety issue/concern may be defined as a performance deficiency and lead to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to remediation, probation and dismissal decision. This must be documented in the resident’s file. 

10.1.8 uncorrected performance deficiencies on any type of assessment may contribute to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to an extension of training, remediation, probation and dismissal decision. 

10.2 Incomplete rotations indicate that:

10.2.1 In traditional stream programs where the rotation supervisor has been unable to properly and fully assess the resident because the resident’s time spent on the training experience was insufficient to support meaningful assessment, additional time on this training experience is indicated to fulfill the requirement. The amount of time will be determined by the competence committee and/or RPC. 

10.2.2 The determination of whether a resident can or cannot be assessed should be made on an individual, case-by-case basis. The assessment should take into account factors such as the resident’s individual performance and experience, the total length of the rotation or training experience, the future time a resident may spend on the same rotation, and the nature of the educational experience being missed. 

10.2.3 In the event that a resident’s performance has been deemed incomplete, the resident may be required to undergo extension of training.

10.3 Where there has been an unsatisfactory or incomplete performance, the program’s RPC must decide what action is required and whether to recommend that the resident be required to enter one of the following remedial periods listed below.  In programs with a competency committee, this decision would be guided by the committee’s recommendations.  In cases where the resident has been referred to the PGME Professionalism Subcommittee, the subcommittee may decide that the resident be required to enter one of the following remedial measures listed below.  A decision of the PGME Professionalism Subcommittee does not require ratification by the Vice-Dean (PGME) or delegate.

10.4 Where concerns have been raised regarding a resident’s performance, the Program Director, or delegate, must review the concerns with the resident.  The purpose of this communication is to ensure a full assessment of the issues as well as disclosure of the evidence and rationale for the concerns.

10.5 The program’s RPC  will review all relevant supporting documentation prior to entering a decision regarding a resident’s unsatisfactory or incomplete performance.  The resident must be provided with the opportunity to address the concerns with the RPC; this communication from the resident may be verbal or written.

11. REMEDIAL MEASURES

11.1 In the event that a resident’s performance has been deemed unsatisfactory or incomplete, the resident may be required to undergo one or more of the following:

11.1.1 extension of training;

11.1.2 remediation; or

11.1.3 probation.

11.2 These remedial measures are intended to address concerns expected to not readily be corrected in the normal course of the residency program.

11.3 A resident may be placed into whichever one(s) of these remedial measures is most applicable to their academic situation.

11.4 In general, it is recommended that a period of probation be preceded by a period of remediation as part of a progressive approach. However, under certain circumstances (e.g. unsatisfactory performance in several CanMEDS domains; level 2 or 3 professionalism concerns; patient safety concerns), the resident may be directly placed on probation without a preceding remediation period.

12. EXTENSION OF TRAINING

12.1 In time-based programs, an extension of training may be utilized to allow a resident to achieve a required level of competence prior to promotion to the next level of training and assuming more clinical responsibilities. This option may be used where the resident has encountered difficulties during the year, difficulties obtaining the next level of responsibility in the program or is on a slower trajectory to obtain required competencies, but such difficulties/trajectory are insufficient to warrant a formal period of remediation or probation, or because the resident has failed a rotation or educational experience that must be repeated. In such cases, the resident will be required to continue training at the same level for a predetermined amount of time, typically not to exceed 12 weeks.  An extension of training may also be required following a reassessment/reclassification where a resident is reclassified at a lower PGY training level and requires extension of time to complete the program training requirements.

12.2 Recommendations for extension of training must be brought to the Program’s RPC by the Program Director or competency committee. A decision regarding an extension of training will be taken by the Program’s RPC.  The decision must be ratified by the Vice-Dean, PGME or delegate.

12.3 The nature and length of the extension of training will be determined by the program’s RPC.  The resident must be consulted about the plan and must be provided with a copy of the plan before the period begins.

12.4 An Extension of Training plan must be completed by the Program which must include the following:

12.4.1 details regarding the reasons for extension of training;

12.4.2 the specific areas of deficiency in the resident’s educational trajectory;

12.4.3 the objectives during the extension of training that need to be met for the expected educational trajectory at the resident’s stage of training;

12.4.4 the methods of assessment during the extension of training;

12.4.5 the duration of the extension of training;

12.4.6 the possible outcomes of the extension of training; and

12.5 If rotation(s) or training experiences are required outside the resident’s program, these will be discussed and arranged with the supervisor of that rotation (or educational experience) prior to finalizing the extension of training.

12.6 The extension of training plan must be ratified by the Vice-Dean (PGME) or delegate prior to its implementation.

12.7 At the end of the Extension of Training period, the RPC or delegate, will review the resident’s performance and determine the appropriate outcomes as per this policy.

13. REMEDIATION

13.1 Remediation is a formal program of individualized training during which the resident is expected to correct identified weaknesses and/or deficiencies where it is anticipated that those weaknesses can be successfully addressed to allow the resident to meet the standards of training. Remediation shall normally be for a period of two to six clinical blocks (approximately equivalent to 2 to 6 months). 

13.2 Recommendations for remediation must be brought to the Program’s RPC by the Program Director or Competency Committee. A decision regarding remediation will be taken by the Program’s RPC. The decision must be ratified by the Vice-Dean (PGME) or delegate.

13.3 A remediation plan must be completed by the Program which must include the following:

13.3.1 details regarding the reasons for remediation;

13.3.2 the specific areas of deficiency, EPAs and milestones or other deficiencies where the resident is off their educational trajectory;

13.3.3 the objectives during the formal remediation; EPAs, milestones and other outcomes that need to be met for the expected educational trajectory at the resident’s stage of training;

13.3.4 the methods of assessment during the remediation;

13.3.5 the duration of the remedial period;

13.3.6 the possible outcomes of the remediation; and

13.4 If rotation(s) or training experiences are required outside the resident’s program, these will be discussed and arranged with the supervisor of that rotation (or educational experience) prior to finalizing the period of remediation.

13.5 The remediation plan must be ratified by the Vice-Dean (PGME) or delegate where the resident’s rotation or training experience is taking place prior to its implementation.

13.6 At the end of a remediation period, the program’s RPC, or delegate, must complete a Final Remediation Outcome form. The Program Director will inform the resident in person and in writing as to the results of the remediation and the recommendation(s) of the RPC. The outcome of the remediation must be ratified by the Vice-Dean (PGME) or delegate.

13.7 A resident may receive credit for training successfully completed during a period of remediation as decided by the RPC.

13.8 If the resident’s performance in remediation is unsatisfactory, the resident will be placed in their home program pending the deliberations of the RPC, or may be placed on a paid interruption in training.  Where the remediation is unsuccessful, the RPC may recommend to the Vice-Dean (PGME) or delegate that the resident enter a further period of remediation or probation.

13.9 A resident may have a maximum 2 remedial periods at any time during a residency program.  Probation and dismissal may be considered as an outcome of a second remedial period; these remedial periods do not need to be consecutive.

14. PROBATION

14.1 A resident will be placed on probation in circumstances where the resident is expected to correct identified serious problems not subject to usual remedial training including but not limited to, academic, professionalism or patient safety issues that are assessed to jeopardize successful completion of the residency program. Probation may be applied where a resident:

14.1.1 has failed a period of remediation;

14.1.2 has successfully completed two remediation periods at any time during their training and subsequently has encountered difficulties; or

14.1.3 has encountered serious academic, patient safety or professionalism issues where the program’s RPC determines that an immediate period of probation is warranted.

14.2 Recommendations for probation must be brought to the program’s RPC by the Program Director or Competency Committee. A decision regarding probation will be taken by the program’s RPC. The decision must be ratified by the Vice-Dean (PGME) or delegate.

14.3 The nature and length of the probation period will be determined by the program’s RPC.  Probation should not exceed 3 rotation blocks/months.  In cases where it has been determined that a resident has acted unprofessionally, probation will be managed in accordance with Faculty of Medicine Professionalism Policy. 

14.4 A probation plan must be completed by the program which must address the following:

14.4.1 details regarding the reasons for probation;

14.4.2 the specific areas of deficiency; EPAs and milestones or other deficiencies where the resident is off their educational trajectory;

14.4.3 the objectives during probation; EPAs and milestones and other outcomes that need to be met for the expected educational trajectory at the resident’s stage of training; 

14.4.4 the methods of assessment during the probation;

14.4.5 the duration of the probation period; 

14.4.6 the possible outcomes of the probation; and

14.5 If rotation(s) or training experiences are required outside the resident’s program, these will be discussed and arranged with the supervisor of that rotation (or educational experience) prior to finalizing the period of probation.

14.6 The probation plan must be ratified by the Vice-Dean (PGME) or delegate where the resident’s rotation or training experience is taking place prior to its implementation.  The senior physician leader of the health organization may be notified as necessary.

14.7 At the completion of the probation period, the resident shall be placed on a paid interruption in training pending the deliberations of the RPC.

14.8 At the end of the probation period, the program’s RPC must complete a Final Probation Outcome form. The Program Director will inform the resident in person and in writing as to the results of the probation and the recommendation(s) of the RPC. The outcome of the probation must be ratified by the Vice-Dean (PGME) or delegate.

14.9 A resident may receive credit for training successfully completed during a period of probation as decided by the RPC.

14.10 Where the probation has been unsuccessful, the Program Director on the advice of the RPC will recommend to the Vice-Dean (PGME) or delegate that the resident be dismissed from the program.

15. SUSPENSION

15.1 Suspension is a temporary interruption of a resident’s participation in the residency program and includes interruption of clinical and educational activities.

15.2 The conduct of residents is governed by the policies of professional bodies such as the CPSO and by the Professionalism Policy of the Faculty of Medicine, University of Ottawa.  Violation of any of these standards and policies may constitute improper conduct warranting suspension. A single serious incident of unprofessionalism or a series of incidents of unprofessionalism may justify suspension.  

15.3 A supervisor may immediately remove a resident from clinical or non-clinical responsibilities if the resident’s conduct is deemed to pose a safety risk to patients, staff, students, or the public that uses the setting.  The supervisor must notify the program director as soon as possible.  Only a program director, Vice-Dean (PGME) or delegate, or the PGME Professionalism Subcommittee may formally suspend a resident.  If the program director suspends a resident, the suspension must be ratified by the Vice Dean (PGME) or delegate.          

15.4 The Vice-Dean (PGME) or delegate must notify the resident in writing of the suspension and the notification must include the reasons for and duration of the suspension.  The resident will continue to be paid during the suspension as per the terms of the PARO-OHT agreement pending review by the Vice-Dean or delegate, and/or the Professionalism Subcommittee.

15.5 The PGME office will notify the senior physician leader of the health organization (Vice Chair Education or delegate) where the resident’s rotation or training experience took place that the resident is suspended from clinical duties pending investigation and adjudication of the issue leading to suspension.  

16. DISMISSAL FROM THE PROGRAM

16.1 A resident may be dismissed from the program if any of the following conditions exist:

16.1.1 a resident has a second failure of remediation;

16.1.2 a resident fails a probation period;

16.1.3 a resident does not maintain the standards of the profession as described in the Faculty’s Professionalism Policy;

16.1.4 a resident meets the criteria of the Regulated Health Professions Act of Ontario for clinical incompetence or incapacitation; or,

16.1.5 lack of a training site/faculty available to train arising from professionalism or patient safety concerns.

16.2 A decision regarding dismissal of a resident will only be taken by the program’s RPC on the recommendation of the Program Director or by the PGME Professionalism Subcommittee. When the decision has been made by the program’s RPC, the decision must be ratified by the Vice-Dean (PGME) or delegate.  Decisions of the PGME Professionalism Subcommittee do not require Vice-Dean (PGME) ratification.

16.3 The resident must be informed of the decision in writing.  The notification must include the reason(s) for dismissal.

16.4 The PGME office will notify the senior physician leader of the health organization where the resident’s rotation or training experience took place that the resident is dismissed from the program.

17. APPEALS 

17.1 A resident has the right to appeal a final decision regarding extension of training, reclassification, remediation, probation, suspension or dismissal as ratified by the Vice-Dean (PGME) or delegate or by the PGME Professionalism Subcommittee to the Faculty Council Appeals Committee. A decision regarding rotation failure for which the consequences are limited to repeating the rotation and/or reducing time available for electives is not eligible for appeal.   

17.2 An appeal is not an opportunity for the resident to repeat the information provided previously during the process leading up to the final decision. The resident’s right to an appeal is not automatic and an appeal will only be considered by the Faculty Council Appeals Committee if it meets the following requirements: 

17.2.1 The appeal to the Faculty Council Appeals Committee must be made in writing and within 10 business days after the date of the final decision that is the subject of the appeal; and

17.2.2 The appeal must include the reasons for the appeal, the reasons why the appeal should be granted, the arguments in support of the appeal and the outcome sought; and

17.2.3 The resident must demonstrate that, 

17.2.3.1 there has been a fundamental procedural error in the making of the final decision and that such error has caused or will cause actual prejudice to the person seeking the appeal (for example: policies and procedures were not followed or the decision-maker did not consider evidence relevant to the final decision); or

17.2.3.2 there are new facts relevant to the final decision that were not available and could not have been provided during the process leading up to the final decision.

17.3 The following is a list of some additional examples of situations where an appeal would not meet the requirements of paragraph 17.2:

17.3.1 The appeal asks for review of a consequence or measure that has not yet been finally decided or approved.

17.3.2 The appeal repeats arguments previously made during the process leading up to the final decision and does not provide any new information relevant to the final decision.

17.3.3 The appeal is based only on a disagreement with a finding of fact, including findings made about the credibility of witnesses.

17.3.4 The appeal raises new arguments that were not made previously, but the resident could have made these arguments during the process leading to the final decision.

17.3.5 The appeal amounts to a mere speculation or a bald statement of a procedural error causing prejudice, and does not provide detailed and convincing information to establish the error and to establish a link between the error and actual prejudice or a reasonable expectation of prejudice to the resident.

17.4 The resident should consult the Faculty Council Appeals Committee procedures (section 9.3 of the Faculty of Medicine bylaws (/faculty-medicine/policies-and-bylaws) concerning the preparation and submission of an appeal and the applicable deadlines.

17.5 While a resident may appeal a final decision regarding extension of training, reclassification, remediation or probation as ratified by the Vice-Dean (PGME), or delegate, or a PGME Professionalism Subcommittee decision to the Faculty Council Appeals Committee, the resident is required to undertake the period of extension, reclassification, remediation or probation plan pending the results of the Appeal.  Failure to do so will result in the resident being placed on leave from training for the duration of the appeal process.  If the appeal is upheld for the resident, the period of training will receive credit to the extent possible.

17.6 While a resident may appeal a final decision regarding suspension or dismissal, as ratified by the Vice-Dean PGME, or delegate, or a PGME Professionalism Committee decision to the Faculty Council Appeals Committee, the resident will remain on leave from training pending the results of the Appeal.

17.7 A resident may appeal the decision of the Faculty Council Appeals Committee to the University Senate Appeals Committee.  The resident should consult the Office of the Secretary-General concerning the preparation and submission of such an appeal and the applicable deadlines.

 
18. NOTIFICATION

18.1 When a resident is assessed by the RPC near the end of the training program as having met the prerequisites for certification by the RCPSC or the CFPC, the Vice-Dean (PGME) or delegate will notify the RCPSC or the CFPC of this in the required manner.

19. GENERAL

19.1 This policy replaces any previous versions of the policies and procedures on PGME evaluations.

20. REVIEW

20.1 This policy will be reviewed 1 year after adoption and every 3 years subsequently.
 

Changes to Clinical Rotations: Administrative Procedure Policy

It is the expectation that residents will complete the rotation schedule as published at the beginning of the academic year.

A program director may switch a resident out of a rotation with a minimum of 6 weeks’ notice to the receiving program. Otherwise, a resident may not be switched out unless the donating program supplies an alternate resident.

The exceptions to this policy wherein a resident may be switched out of a rotation without due notice or supplying an alternate are:

1. Unexpected serious illness of the resident.
2. Academic difficulties such as failure of a rotation or the requirement for remediation or probation.
3. Pandemic or other disaster-related redeployment.
    

*no changes were made from the previous version, therefore no further approvals needed.

Clinical Fellowship Policy

DEFINITION

A fellow is a postgraduate medical education trainee undertaking post-certification educational training outside the specialty or subspecialty residency training requirements of the RCPSC or CFPC. A fellowship cannot be credited toward national certification requirements.

REQUIREMENTS

1. A postgraduate fellow must be eligible for a license with the College of Physicians and Surgeons of Ontario (refer to the CPSO website for specific requirements).
2. All clinical fellowships must have clearly defined written educational goals and objectives, as per the standards of the College of Physicians and Surgeons of Ontario.
3. There must be a designated Fellowship Director.
4. New fellowship programs must be reviewed and approved by the Vice-Dean, PGME prior to offering a candidate a fellowship position.
5. The fellowship director must review the planned number of fellows with any affiliated residency program director and Department Chair to ensure it will not negatively impact residency training.  The Department Chair or delegate will make the ultimate decision on number of fellows.
6. Fellowships must include formal periodic and final evaluation of performance (ITER).
7. All fellows who wish to have their training recognized by the University of Ottawa must be registered as a postgraduate trainee with the Faculty of Medicine. A registered fellow will receive a certificate of completion of training, upon confirmation of satisfactory completion by the fellowship director and/or affiliated program director.
8. The term of a fellowship is a minimum of 6 months and a maximum of 3 years. Any fellowship shorter than 6 months requires the approval of the Vice Dean of PGME or delegate.  Any trainee who wishes to complete more than 3 years of fellowship training at the University of Ottawa requires approval of the Clinical Fellowship Committee.  In such cases, the fellowship program director must present to the committee in person to justify the fellowship.
9. 91��Ʒ���ϳԹ� PGME full-time Clinical Fellows are required to have the opportunity to earn or be provided a minimum of $70,000 / year as their fellowship salary, as per the “Salary for Clinical Fellows Policy”.
10. Each fellowship program is required to institute a regular formalized review of the program.  The individual ultimately responsible for oversight of regular formalized reviews is the Departmental Fellowship Lead.
     

Potential Conflict of Interest During Clinical Supervision Due to a Personal Relationship Policy

The Faculty of Medicine recognizes the inherent conflict of interest potential and the difficulties that arise when a close relative is involved in the supervision and evaluation of another close relative in the student or resident role.

The University of Ottawa recognizes a close relative in the context of its policy on professional ethics as any parent, spouse, son, daughter, brother, or sister, or any person who has the same home as the faculty member, or a treating physician, or an individual within whom the trainee has a close relationship.

The policy of the Faculty thus is that no faculty member should supervise or evaluate a close relative or other person with whom they have a significant personal relationship, in the performance of their academic or clinical roles, except during occasional supervision of on-call duties, if the latter cannot be avoided. Faculty must remain sensitive to all potential conflicts of interest with regards to supervision and deal with them in a professional manner.
 

*no changes were made from previous version, therefore no further approvals needed. 

Conflict Resolution Policy

PGME Evaluation Roles & Responsibilities

Policy on Information Management

Leave of Absence Policy

PREAMBLE

Residency programs define specific time requirements for training. It is recognized that a resident may require one or more interruptions of training for personal and professional reasons. Such interruptions are referred to as leaves of absence. This policy outlines the Postgraduate Medical Education (PGME) processes and procedures to review and grant leave of absence requests, including salary level implications, and impact on certification exam eligibility. 

SCOPE

• This policy applies to all Ministry of Health (MOH) funded residents registered with the PGME Office.
• AFC trainees, Clinical and Research Fellows should contact the department overseeing their training with respect to contractual leaves policies and procedures.
• The PGME office will abide by any stipulations regarding leaves of absence provided for in the PARO-OTH Collective Agreement as well as in sponsorship contracts (e.g. Gulf sponsored residents from Saudi Arabia, Kuwait, Oman, United Arab Emirates, Bahrain, or Qatar); it is recognized that the PARO-OTH Collective Agreement also provides for employee benefits to sponsored residents.

RELATED DOCUMENTS

A number of important documents govern leaves and their impact on certification exam eligibility. This policy and procedure is not intended to supersede these documents but will serve to assist in their interpretation and application.

1. . The PARO-OTH agreement outlines the employment relationship between residents and the Ontario teaching hospitals. This agreement establishes entitlements relating to pregnancy and parental leaves, sick leave, vacation, and professional leave.
2. Leaves from Ontario Postgraduate Residency Programs (May 2015). The COFM leave guidelines provides direction on a number of issues including conditions to be met upon taking leave from and returning to the program and granting of unpaid leaves.
3. (RCPSC) Policies for Certification in a Competence by Design Model of Residency Training (Oct 2022) The policy sets out examination eligibility requirements (Section II) and residency training requirements (Section III).  
4. sets out requirements for completion of postgraduate medical education in Family Medicine. 

DEFINITION

A leave of absence is defined as an approved interruption of training for any reason. Leaves may be taken for a variety of reasons but are generally categorized into leaves with pay and leaves without pay.

GENERAL PRINCIPLES and RESPONSIBILITIES

Residents

1. The resident’s professional responsibility is to ensure that the Program Director (PD) and Program Administrator (PA) are notified regarding their request prior to the start of the proposed leave. It is recognized that this will not always be possible in urgent circumstances and, in such cases, will not affect the approval for the resident’s leave. In urgent circumstances, the resident must notify the faculty supervisor and/or Chief Resident to ensure that an alternative can be found for the provision of clinical care.
2. In addition to informing their program of a medical leave, residents may be requested to send medical notes for any medical illness longer than three (3) days directly to the Wellness Office ([email protected]), who are the health information custodians for medical information.  Wellness will then notify the  PGME office.
3. Residents on approved leave will remain registered with the PGME Office, notwithstanding their inactivity and are expected to maintain a standard of conduct in keeping with the standards of the residency program, the University, and the medical profession at large.
4. Residents on approved leave must sign and date a Letter of Appointment for the purpose of licensure with CPSO, pay the registration fee, and complete other registration requirements annually to remain registered with the PGME Office. Refer to the PGME Website for more information.  
5. Residents must be aware of their professional obligations to report leaves to the CPSO when applying for or renewing licenses. Failure to disclose leaves from the training program may result in delays in license renewal as a result of investigation and/or disciplinary action.
6. If there is a WSIB claim, please refer to this link for incident reporting.
7. At the end of a leave of absence, residents must return to their home residency program.
8. Time lost during a leave must be made up ( orthe equivalent time in the residency program) upon the resident’s return to the Program. Residents will normally be required to complete all mandatory/elective components of the Program. In special cases, a waiver of training may be requested at the discretion of the PD and the Residency Program Committee (RPC). See policy on Waiver of Training.
9. During a leave of absence, residents will be classified in the same postgrad year (PGY) level they are at the start of their leave.
10. Salary and benefits continuation is determined by the type of leave and in accordance with the PARO-OTH Collective Agreement.
11. Residents must notify their home PD and administrator of their return date. For leaves over six (6) months, the resident must notify the program at least four weeks in advance of the return date or of the proposed leave.

Program

1. All submissions for leaves from residents will require the program to review and approve beforehand, with appropriate documentation provided to PGME.
2. Unless required by the PD or for purposes of the Record of Employment, leaves of seven (7) days or less are not required to be submitted to the PGME Office.
3. If there is a WSIB claim, please refer to this link for incident reporting.
4. Programs must provide PGME with plans should residents return to training with requirements for accommodations or part-time work plan.
5. In all cases, the PD, in discussion with the RPC and returning resident, should determine:
   1. the required make up time;
   2. the Competence by Design (CBD) stage of training and training level to which the resident will return following the leave; and
   3. the necessary educational experiences required for the resident to complete the residency requirements and goals and objectives of the training program.
6. For Family Medicine, residents must complete twenty-four (24) months of training in accordance to CFPC guidelines.  For any interruption of training, it is expected that the resident will make up time on rotations missed with equivalent time upon return to the program.  Should a waiver of training be granted, the CFPA Board of Examinations and Certification must be notified prior to the submission of completion of training – the maximum length of a waiver of training is four (4) weeks.  
7. Family medicine residents registered in enhanced skills programs for one (1) year or less must complete the entire duration of training to be eligible for CFPC examinations leading to Certificates of Added Competence and/or attestations of completion of training.

Postgraduate Office

1. The PGME Office will notify the College of Physicians and Surgeons of Ontario (CPSO) and PARO (long-term leaves) of all interruptions in training greater than one (1) week, as reported by the Program Director. The PGME Office will abide by governance as established in
   1.  
   2. Council of Ontario Faculties of Medicine (COFM) document, Leaves from Ontario Postgraduate Residency Programs, May 2015
   3. RCPSC Policy for Certification in a Competence by Design Model of Residency Training (Section III)
   4. PARO-OTH Collective Agreement

TYPES OF LEAVE

Paid Leave 

1. Pregnancy and Parental Leave: Entitlement to pregnancy and parental leave is addressed in Section 15 of the PARO-OTH Agreement.
2. Medical/Sick Leave: Residents are entitled to up to six (6) months of paid leave for illness or injury. If the resident requires a prolonged medical leave greater than six (6) months, they may be eligible to receive pay and benefits through Long Term Disability.  Further details on Long Term Disability and other entitlements regarding illness or injury are addressed in Section 14 of the PARO-OTH Agreement.  Upon return to training, it is the resident’s responsibility to inform the Program and PGME if they require accommodation(s), a gradual return to work plan, or a change to part-time status.  All required documentation must be submitted to the Faculty Wellness Program prior to the resident’s return to work start date. Medical Note: if a resident is sick for an extended period of time (more than seven (7) days), they will be required to provide a doctor’s note. Doctor’s notes must be sent to the Faculty Wellness Program ([email protected]), who will relay the information to the PGME office.
3. Professional Leave: Residents shall be granted educational leave up to a maximum of seven (7) working days per year; shall be consecutive if requested by the resident, and shall not be deducted from regular vacation entitlement. Residents shall be granted additional paid leave to take Canadian or American certification examinations.  For further details, refer to Section 12 of the PARO-OTH Agreement .
4. Vacation: Residents are entitled to four (4) weeks of paid vacation per year.  Vacation entitlement accrues while on maternity/parental leave. Vacation time must be taken within the academic session and cannot be rolled over or “stockpiled” to the next year, or counted towards waived training time. In addition, vacation time should not be carried over when the resident enters a sub-specialty program. Hospitals may not restrict the amount of vacation a resident can take in a rotation but do have the right to delay a vacation request with regard to professional and patient care responsibilities.  For further details, refer to Section 11 of the PARO-OTH Agreement.
5. Emergency, Family, Bereavement Leave: A resident may request a leave due to a death in the immediate family or a person with whom the resident had a close relationship. A leave may also be requested due to family illness, injury, medical emergency, or other urgent family matters to which the resident must attend. A maximum of five (5) consecutive working days may be granted by the PD. 

Unpaid leave 

1. Educational Leave: A resident may request an unpaid educational leave on the basis that the time away from the residency program is relevant to his/her current program. The request must be supported by the PD, and approved by the Postgraduate Dean or designate. The maximum educational leave period is usually one (1) year.  The Program must ensure there are no anticipated negative effects on return to training at the appropriate level and timely completion of the training program prior to the approval of an education leave.  The PD must provide the PGME office with notification, including the duration of the educational leave and the expected return date. Leaves beyond one (1) year will be assessed by the RPC, PD and the Postgraduate Dean or designate.
2. Personal/Compassionate Leave: A resident may request an unpaid leave of absence due to a personal situation, career uncertainty or for other reasons. These leaves will be considered on an individual basis, discussed and reviewed for approval by the PD in consultation with the RPC and the Postgraduate Dean or designate. The maximum leave period in this category is six (6) months. 

SALARY CLASSIFICATION

• Residents will normally advance to the next pay level upon their successful completion of twelve (12) months (13 blocks) of training.
• During a leave of absence, residents will be classified in the same postgraduate year (PGY) level they are at the start of their leave.
• Salary and benefits continuation is determined by the type of leave and in accordance with the PARO-OTH Collective Agreement. 

RETURN TO TRAINING

• Residents returning after a medical leave will provide a written medical certificate from their treating physician to the Wellness office ([email protected]) indicating the resident’s capability and fitness to return to the program. The PD or the Postgraduate Dean or designate may request an additional independent medical opinion to ensure the resident’s capability to resume their residency program.
• Normally residents will return to the program at the same level as when the leave was taken.
• Residents returning to training after a prolonged  absence may require a modified learning plan or reassessment/reclassification.
• In order to decide on the appropriate training level and program structure, residents may be assigned a 4-12 week period of reassessment, structured and organized by the PD in consultation with the RPC and educational programming resources.  PGME Director of Academic Support and other PGME resources may be utilized to assist the program.
• The RPC, will review the results of the assessment and the PD will submit a recommendation to the Postgraduate Dean or designate regarding the resident’s re-entry to training.
• If approved, the PD will discuss with the resident the modified program structure, training level, the evaluation process, and expected outcomes.
• An accommodation plan must be submitted and approved by the Faculty Wellness Program and the Program. There may be changes to pay for part-time accommodation plans.
• If a RPC recommends against a resident’s re-entry to the training program, the policy outlining the conditions for dismissal apply.  The PD must inform the Postgraduate Dean or designate and the recommendation will be reviewed by the PGME Evaluation Subcommittee. The decision will be communicated with the resident by the PGME Office. Any appeals would follow the normal Faculty and University Appeals process. 

PROCESS

1. Resident requests the leave and submits it to their PD and PA for approval.
2. All leaves must be approved by the Resident’s Program Director.
3. In addition to informing the program of a medical leave, residents must send medical notes directly to the Wellness Office ([email protected]), who will then notify the  PGME office.
4. If there is a WSIB claim, please refer to this link for incident reporting.
5. The Program submits a to inform the PGME Office of the leave.  
6. All leaves greater than seven (7) consecutive days must be reported to the PGME Office. There may be special circumstances when the Program will report a leave for less than 7 days (i.e. a pattern of missed days by a resident within a specific time frame resulting in a resident’s ability to successfully complete training objectives), or resulting in unprofessional behaviour.
7. When Bereavement Leave is required, the resident will contact the PD and PA as soon as possible to specify the number of days needed and to request approval.
8. The Postgraduate Dean or designate must be informed of and approve all unpaid leaves. A letter of support from the PD must be sent to PGME’s Registration Coordinator ([email protected]), who will proceed with obtaining the Postgraduate Dean’s approval.
9. All leaves reported to the PGME Office will be reported to the College of Physicians and Surgeons of Ontario (CPSO) and PARO (LTD).
10. For medical leaves that extend into a new academic year, the resident or their delegate will provide a report to their PD on the status of their leave. Privacy is respected, and confidential medical information will not be required. The PD will inform/update PGME regarding the status of the resident to create a Letter of Appointment (LOA) for the resident.
11. While on medical leave, salary and benefits will be maintained and continued until the end of the medical leave, for up to six (6) months, or the end of the resident’s appointment year, whichever occurs first. The appointment year is determined by the resident’s training start date. During a medical leave, the resident’s salary and benefits continuance will be applied as defined by section 14.1 of the PARO-OTH Collective Agreement.

RETURNING TO TRAINING AFTER A LEAVE

1. PGME must be informed if there is a change in the return date from the original leave request. The program must let PGME know through the . This will ensure that pay and benefits will resume on the correct date.
2. All residents are required to complete all mandatory and elective components of the program.  PDs may consider a waiver of training if training requirements have been met and the resident has achieved the mandatory competencies of the Program.
3. Residents may require an accommodated or modified/gradual return to work plan or request part-time training following a medical leave.  Programs are required to provide PGME with this information via the prior to the resident’s return to training (allowing up to a grace period of seven (7) days after the resident’s return).  All parties must understand any ramifications for extension of training and/or changes to pay for part-time training and accommodation plans.
4. Residents must send medical or accommodations notes directly to the Wellness Office ([email protected]), who will then notify the  PGME office.
5. For leaves under one (1) year in length, it is expected that residents will return to the same program and training level they were in prior to the leave.
6. After a prolonged leave (greater than twelve (12) months), Programs shall determine the level of training and required educational experiences and competencies necessary to complete the training program.

Policy 67a: Prevention of harassment and discrimination

Policy 67b on the Prevention of Sexual Violence was adopted by the Senate on Monday, June 13, 2016 and by the Board of Governors on Monday, June 27, 2016.

Read Policy 67b on the Prevention of Sexual Violence.

Procedure for an Appeal to the Senate Appeals Committee

Professionalism Policy

Resident Research & Scholarly Project Policy

All residency programs must ensure that residents are provided opportunities to participate in research or other scholarly projects as defined within the goals and objectives of each program. Resident research or scholarly projects during the course of their residency program could include: basic science; primary care research, experimental medicine; clinical medicine; epidemiology; quality assurance; medical education; ethics; humanities and medicine or any research aligned with health care. 

According to the General Standards Applicable to All Residency Programs. 

Element 3.2 : The residency program provides educational experiences designed to facilitate residents’ attainment of the outcomes-based competencies and/or objectives.

• Requirement 3.2.5 : The educational environment supports and promotes resident learning in an atmosphere of scholarly inquiry.
  • Indicator 3.2.5.1 : Residents have access to, and mentorship for, a variety of scholarly opportunities, including research as appropriate.
  • Indicator 3.2.5.2 : Residents have protected time to participate in scholarly activities, including research as appropriate.
  • Indicator 3.2.5.3 : Residents have protected time to participate in professional development to augment their learning and/or to present their scholarly work.

Element 4.2 : The residency program has the appropriate human resources to provide all residents with the required educational experiences.

• Requirement 4.2.1 : Teachers appropriately implement the residency curriculum, supervise and assess trainees, contribute to the program, and role model effective practice.
  • Indicator 4.2.1.3 : There are sufficient competent individual supervisors to support a variety of resident scholarly activities, including research as appropriate.
  • Indicator 4.2.1.4 : There is a designated individual who facilitates the involvement of residents in scholarly activities, including research as appropriate, and who reports to the residency program committee.

PROCEDURES

• Each Program must have an assigned Resident Research Director to facilitate resident participation in research and other scholarly projects.
• There must be appropriate faculty members identified to facilitate and supervise resident involvement in a research or scholarly project.
• Resources to support resident research are a Departmental/Divisional responsibility.
• Programs are required to maintain a list of all research and scholarly projects completed by their residents.

All projects are to conform to the Faculty of Medicine’s policy on Research. 

*No changes nor amendments were required. Per process, it was not required to be presented to the Faculty Council or the Senate, as no modifications were made.

Resident Selection Policy

APPLICATION

The University of Ottawa believes that the best residents are those who have been able to explore the breadth of the medical profession through a variety of electives while enrolled in medical school. We encourage trainees to use elective time to establish a broad portfolio of expertise as opposed to focusing exclusively on a single specialty.

Each program is responsible for establishing a selection process for prospective residents, which must be in accordance with the General Standards of Accreditation, the , Best Practices in Resident Applications and Selection (BPAS) and adhere to the Faculty of Medicine’s . Adhering to these standards ensures a fair and transparent selection process free from discrimination, harassment and preferential treatment.

For PGY1 entry positions, the Family Medicine 3rd year enhanced skills match, as well as other subspecialty matches, programs must also adhere to the policies and procedures of the (CaRMS), the Association of Faculties of Medicine of Canada (AFMC) as well as manage the process in accordance with their own policies and guidelines. Failure to do so may result in the application of sanctions to that program, which may include forced withdrawal from the match by the program.

All resident selection committee members must have completed an unconscious bias module or training session, such as the one offered by PGME prior to serving on a selection committee.
 

Interactions Between the Faculty of Medicine and the Pharmaceutical, Biotechnology, Medical Device, and Hospital and Research Equipment and Supply Industries.

Policy on Residents Working Additional Hours for Pay
(formally known as "Moonlighting Policy")

DEFINITION

Residents are only permitted to undertake what is commonly referred to as “moonlighting”, and will henceforth be termed “Residents Working Additional Hours for Pay”, in the following scenarios:

1. When holding an Independent Practice License from the College of Physicians and Surgeons of Ontario (CPSO) and undertaking additional hours for pay outside of their regular clinical duties.
2. When holding a certificate of Restricted Registration from the CPSO, obtained through Restricted Registration Ontario, and undertaking additional hours for pay outside of their regular clinical duties.
3. The Province of Ontario has issued an Order-in-Council (OIC) permitting other forms of moonlighting arising from/during exceptional circumstances e.g. Pandemic or other disaster

The Council of Ontario Faculties of Medicine (COFM) defines practicing with a Restricted Registration as: 

• Residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) who provide clinical services for remuneration outside of the residency program with a .

APPLICATION

As per the COFM and the CPSO, residents cannot legally work additional hours for pay outside of their residency program without an Independent Practice License or certificate of Restricted Registration.

Moreover, of regular clinical duties under a certificate of Restricted Registration, specifically, must not contravene the PARO-OTH Collective Agreement (e.g. exceed ).  

Information on the Restricted Registration Program, and obtaining a certificate of Restricted Registration may be found .

Salary for Clinical Fellows Policy

PURPOSE

PGME Clinical Fellows are post-residency physicians undergoing specialized training in a fellowship that may or may not be accredited by the RCPSC or CFPC. Clinical Fellows are not residents and as such, do not follow the PARO-CAHO contract. In order to assure that Clinical Fellows have a living wage, it is imperative to set a base earning level.

 
APPLICATION

91��Ʒ���ϳԹ� PGME full-time Clinical Fellows are required to have the opportunity to earn a minimum of $70,000 / year for fellowship training. This can be achieved by but is not limited to:

1. External Funding by a third party, e.g Hospital Foundation, Charitable Organization, Governmental Agency
2. Salary Support by Hospital / University Department / Research Institute
3. Own clinical earnings i.e. have the ability to generate at least this amount through clinical practice.
    

Policy for Supervision of Postgraduate Trainees

PURPOSE

The purpose of this policy is to provide requirements and general guidelines for supervision of postgraduate medical trainees. More specific program policies and guidelines that reflect the unique needs of each discipline are the responsibility of each residency program and must incorporate all points in this policy. Hospital and/or clinical setting policies may also dictate the additional availability and responsibilities of the faculty supervisors in patient care and diagnostic settings.

This policy is in compliance with but does not supersede the following policies, guidelines and standards:

• Accreditation Standards for Residency Programs ()

DEFINITIONS

PGEC: Postgraduate Education Committee, Faculty of Medicine, University of Ottawa.

PGME: Postgraduate Medical Education at the University of Ottawa.

Postgraduate Medical Trainee (henceforth called Trainee): a postgraduate medical trainee (resident, AFC trainee or fellow) who is enrolled within a postgraduate program under the oversight of the Postgraduate Medical Education office. 

1. All medical trainees must be licensed through CPSO.
2. A Resident is a trainee who must abide by the PARO-OTH collective agreement
3. Regardless of registration status or stage/level of training, Trainees are deemed to be in training and requiring supervision by a postgraduate Supervisor.
4. Trainees may serve in the role of supervising more junior learners, but do not act as the MRP and also must have a Supervisor for patient care.
5. Trainees may provide teaching to UGME learners.

Stages of training: in Royal College (RC) competency based medical education terminology, stages of training refer to four developmental stages: 

1. transition to discipline,
2. foundations of discipline,
3. core of discipline and
4. transition to practice. 

Each stage has its own set of markers for learning and assessment, and as trainees move through the stages, increasing supervisory tasks may be delegated to them.

Supervisor: a faculty member who has direct responsibility to oversee the work of postgraduate medical trainees in a particular practice or service. The Supervisor may be:

1. The Most Responsible Physician (MRP)
2. Consultant supervisor
3. On-call physician

PRINCIPLES

Supervisors have a dual professional responsibility to provide high quality, safe, ethical patient care and appropriate supervision of, and education for Trainees. Supervisors must provide adequate oversight of the Trainee after careful assessment of the appropriate level of responsibility that can be delegated to the Trainee. Additionally, Supervisors should appropriately allow opportunities for Trainees to assume graduated responsibilities based on their assessed knowledge, skills, competencies and stage of training.

Supervisors must take action to support delivering a positive training experience in a safe learning environment. A psychologically safe learning environment is defined as being conducive to behaviours such as speaking up or asking for help ().

Postgraduate medical trainees are licensed physicians and have a professional responsibility to ensure that patients (and/or their families) to whom they are providing care know that they are working under the supervision of a faculty Supervisor and have a duty to inform the Supervisor about their patients.

1. The Supervisor and Trainee together determine the appropriate degree of independence for a trainee in any given clinical or on call situation, with the goal of providing a learning environment that enables high quality patient care and appropriate educational support to trainees. The degree of availability of an MRP and/or supervisor and the means of availability (by phone, pager or in-person) must be appropriate and reflective of the following factors:
   1. the patient’s specific circumstances (e.g., clinical status, specific health-care needs);
   2. the setting where the care will be provided and the available resources and environmental supports in place; and
   3. the education, training and experience of the postgraduate trainee.

GENERAL GUIDELINES OF APPROPRIATE CLINICAL SUPERVISION

1. Acting in the best interest of the patient is central to the role of the Trainee and Supervisor interaction.
2. Professionalism is essential in all interactions in the learning environment in order to provide the best care to patients. This is demonstrated in a model of professional, ethical and compassionate care to promote a safe, supportive and collaborative learning environment free of intimidation, harassment or discrimination.
3. All learning environments must promote an open and free exchange of ideas, questions, discussion and feedback between Trainees and Supervisors to optimize patient care and learning.
4. Communication from Supervisors must enable the Trainee to voice concerns about a delegated task and request assistance at any time.
5. Programs guide the determination of the degree of supervision required for the level of training and clinical situation.
6. Trainees and Supervisors must know how to reach each other at all times while on duty.
7. The call schedule must be structured to provide Trainees with continuous supervision commensurate with the trainee’s level of competence 24 hours a day, 7 days a week.
8. For residents, clinical work, including on-call duties, must conform to the PARO-OTH Collective Agreement. Supervisors must ensure that Trainees are relieved of duties post-call under the terms of the Agreement.

ROLES AND RESPONSIBILITIES

Faculty Supervisors Must:

9. Review and be familiar with the learning objectives of the Trainee for the duration of the Supervisor-Trainee relationship, prior to undertaking supervisory responsibilities.
10. Complete written assessments and identify concerns of clinical performance using appropriate program assessment forms which may include (but not exclusive of) EPAs, ITERs, ITARs, daily evaluation forms, O-SCORE, etc.
11. Regularly assess the Trainee’s learning needs and clinical competence (knowledge, skill, judgement) to assign appropriate graduated responsibility for patient care.
12. Review all new patient admissions and consultations completed by a Trainee in a timely manner.
13. Regularly review medical documentation completed by the Trainee to ensure accuracy, with provision of coaching or feedback as appropriate for ongoing improvement.
14. Evaluate the clinical situation and stage of training/competency of the Trainee when delegating tasks and determining the degree of supervision required, including procedural skills:
    1. Ensuring any procedures performed by the Trainee is within their competence level
    2. Directly supervise procedures if required for patient safety or if requested by the patient or Trainee
    3. Ensure their own competence for any clinical tasks and procedures for which they are supervising the Trainee
15. Understand their professional liabilities as a physician if patient care tasks are inappropriately delegated to Trainees without ensuring proper supervision
16. Ensure the patient or substitute decision-maker is informed of:
    1. The identity of the MRP
    2. The MRP has ultimate responsibility for the patient care decisions
    3. The identity of the Trainee(s) who is a member of the healthcare team and their involvement in patient care
17. Provide support and direction to the Trainee including:
    1. Addressing conflict around patient care
    2. Identifying strategies for effective conflict resolution
    3. Intervening on behalf of the Trainee when necessary
18. Be accessible, willing and available to assess the patient when requested to do so by the resident or as required based on the clinical status of the patient.
    1. Should there be a situation where the Supervisor is unavailable, the Supervisor must ensure that an appropriate alternative faculty member is available to take their place, including agreeing to supervise the Trainee.
    2. Should there be a transfer of care and supervision, this information must be communicated to all team members in a timely fashion
19. Have effective communication methods regarding patient care, including:
    1. being available for handover for on-call activities.
    2. communicate the necessary information about a patient’s condition to the resident
    3. responding to pages, texts or phone calls within a reasonable length of time defined by the discipline and clinical context
20. Provide information and reporting of safety concerns to the Program or the relevant divisional/departmental/hospital authority on the following:
    1. Patient safety concerns
    2. Trainee safety concerns
    3. Mistreatment concerns
    4. Supervision concerns
    5. Learning environment concerns
    6. Professionalism concerns
21. Be responsible for supporting and sustaining a learning environment which is safe for the Trainee to acquire the knowledge and skills set out in the training and learning objectives.
22. Be aware that Trainees may not recognize their own limitations and take on more responsibility than is appropriate. The Supervisor is responsible for recognizing when a Trainee is unable to provide safe patient care due to number, complexity of patients assigned or other factors and intervening to support the Trainee.
23. Be aware and recognize signs of fatigue that could potentially impair judgement of a Trainee. The Supervisor has a duty to intervene to ensure that patient care is appropriate while also supporting the well-being of the Trainee.
24. Be aware that there is a collective agreement in place between PARO-OTH and that there are specific entitlements that must be adhered to.
25. Be aware that accommodations may be in effect for the Trainee that they are supervising, and when informed should apply as appropriate.
26. Know about Trainee mistreatment, how to prevent it, and provide guidance on when / where to report issues of professionalism.

Trainees Must:

27. Review learning objectives with the Supervisor at the beginning of each rotation, shift or on-call.
28. Inform each patient and/or family member of their status as a Trainee and provide the name of their Supervisor and the MRP (if not the Supervisor).
29. Recognize and be aware of the limits of their knowledge, clinical and procedural skills
    1. Ensure that they practice within their competence and seek assistance appropriately
    2. Notify the Supervisor of these limits when delegated clinical tasks
    3. Express concerns if asked to perform tasks beyond their abilities
    4. Request for direct supervision when asked to perform tasks where they have limited experience
30. Communicate with the Supervisor immediately when:
    1. A patient’s condition deteriorates significantly
    2. In any emergency situation when the patient is at risk
    3. A procedure with potential significant risk is being considered for the patient
    4. The patient or family member expresses concerns
    5. If any management actions have the potential to harm the patient or have resulted in patient harm
31. Communicate with the Supervisor in a timely manner as determined by program policy when:
    1. A patient is admitted to hospital
    2. A patient is discharged from hospital
    3. The diagnosis of the patient is in doubt and there is concern about potential patient harm
    4. There is uncertainty regarding the management plan and there is concern about potential patient harm
    5. An outpatient (e.g., emergency room or clinic) has been examined or treated
32. In the interest of patient safety, inform the Supervisor if they are not able to care for all the patients delegated to them.
33. Inform the Program Director (PD) and/or delegate (examples include Division/Department Head, site education lead, etc.) when they believe that they have insufficient supervision and/or the Supervisor is not responsive to their requests for assistance.
34. For any single breach of the PARO-OTH Collective Agreement, Inform the PD and/or the Supervisor, or the Program Administrator.
35. For any recurrent breach of the PARO-OTH Collective Agreement, inform the PD and/or PGME and/or PARO.
36. Know when, where, and how to report issues of professionalism or mistreatment (Reporting Tool).
37. Provide information as required, relating to accommodations or matters of wellness, specific to the functional limitations, to the extent that it may require modification of shifts and/or learning objectives.

PDs and Program Committees Must:

38. Review, ratify and disseminate the central PGME Policy for Supervision of Medical Trainees and any supplementary program-specific guideline/policy.
    1. Each program may develop program specific supervision policies or guidelines to supplement this policy to reflect the nature and general organization of their training program.
    2. Program specific supplementary policies or guidelines should outline rotation specific factors and supervision expectations for after-hours work which may include clinics or home visits.
    3. Identify program specific expectations for communication strategies between Trainees and Supervisors.
    4. Identify program specific expectations for communication if they are unable to reach the designated on-call Supervisor.
39. PGME and program policies on supervision are reviewed during formal orientation sessions and made readily accessible to Trainees.
    1. Ensure that the Trainee understands their roles and responsibilities in the provision of clinical care.
    2. Ensure that the Trainee is aware of and complies with policies regarding disclosure of their trainee status to patients.
    3. Ensure that the Trainee understands their role and expectations to communicate with and notify the Supervisor for clinical decisions.
    4. Ensure that Trainees and Supervisors have clear expectations around appropriate mechanisms for and communications of patient information for handover.
    5. Ensure that the Trainee understands mechanisms of reporting in cases of inadequate supervision.
40. PGME and program policies on supervision are provided to and readily accessible to all Supervisors.
    1. Ensure all Supervisors are aware of and comply with the PGME and any supplemental program policies on supervision.
    2. Provide Supervisors with Trainee learning objectives and assessment requirements, including timelines for completion.
41. Ensure that the Trainee is adequately supervised and that Supervisors are assessed appropriately.
    1. Provide a fair process, free from reprisal, for assessment of Supervisors, which includes adequacy of supervision.
    2. Provide regular written evaluations to Supervisors of their teaching and supervisory roles.
    3. Provide a clear mechanism of reporting of Trainee concerns about quality and level of supervision they are receiving.
    4. Ensure a mechanism for Trainees to report concerns of mistreatment.
42. Each PD and program faculty have a responsibility to report any egregious unsafe or unprofessional supervisory behavior by faculty members.
    1. In the event that a Supervisor consistently fails to provide adequate supervision to Trainees, the Division Head or Department Chair is to be informed and will work with Hospital Leads (Chief of Staff office), PGME and Faculty Affairs to address the matter in accordance with article 7.3 within the Faculty of Medicine Professionalism Policy.

PGME Must:

43. Ensure that the central PGME policy for supervision is reviewed on a regular cycle of 3 years and approved by PGEC to be compliant with required regulations and standards.
44. Ensure that the central policy is disseminated and freely accessible to all programs and trainees, and readily accessible by faculty members.
45. Assist programs to develop any supplementary program specific guidelines
46. PGME will maintain an accessible and appropriate process for Trainees to report issues regarding supervision and provide support for Trainees where there is an identified need regarding the implementation of this policy.
47. PGME will contribute to providing a safe and supportive environment that allows postgraduate trainees to make a report if they believe the MRP and/or their supervisor does not provide sufficient supervision, in a manner where trainees will not face intimidation or academic penalties for reporting such behaviours.
48. PGME will provide support to Programs where there are issues identified regarding the implementation of this policy.
49. PGME will work in conjunction with Department Chairs, hospital leadership and Faculty Affairs to address unprofessional supervisory behavior by faculty members.
     

Postgraduate Trainee Safety Policy

INTRODUCTION

The Postgraduate Medical Education (PGME) Office recognizes its role in providing postgraduate trainees with a safe environment during their training. The responsibility for promoting a culture and environment of safety for postgraduate trainees rests with the University, the Faculty of Medicine, program leadership, affiliated training sites, clinical departments, and trainees themselves. The concept of postgraduate trainee safety includes physical, psychological, and professional security. This central policy is augmented at the level of the Residency Program Committee (RPC) to respond to the program specific context.

Trainees who feel that their personal safety is threatened during the performance of their training duties should remove themselves from the situation as quickly as possible, seek immediate assistance and report the incident to their supervisor. 

Safety policies and procedures should be available from the program, program director or clinical leader as appropriate.  Standard program orientation includes informing the trainee of these policies and having the information readily available for review at any time.

REPORTING

Trainees who identify a threat to personal safety must report it to their immediate supervisor or program director. Alternate avenues of reporting may include Division/Department leadership, ombudspersons and directly to the postgraduate office, as appropriate.  

Reporting issues related to the learning environment with disruptive or unprofessional conduct can also be done using the .  Reporting can be submitted anonymously if needed but anonymity may limit the ability for follow-up and/or corrective action. 

Accidents, incidents, and environmental illnesses occurring during postgraduate training should be reported and administered according to the reporting policies and procedures of the University, Hospital or clinical teaching location.  Policies and procedures should be available from the program or clinical leader as appropriate.

KEY RESPONSIBILITIES

1. For postgraduate trainees:
   1. to provide information and communicate safety concerns to the program.
   2. to comply with safety policies.
2. For postgraduate training programs:
   1. to act promptly to address identified safety concerns and incidents.
   2. to be proactive in providing a safe learning environment.

PHYSICAL SAFETY

1. Relating to travel
   1. When postgraduate trainees are traveling for clinical or other academic assignments by private vehicle, it is expected that they maintain their vehicle adequately and travel with appropriate supplies and contact information.
   2. For long distance travel for clinical or other academic assignments, it is expected that postgraduate trainees will ensure that a colleague or the home program office is aware of their itinerary.
   3. Postgraduate trainees are not to be on call the day before long distance travel for clinical or other academic assignments by car. When long distance travel is required in order to begin a new rotation, the trainee must request that they not be on-call on the last day of the preceding rotation. If this cannot be arranged, then the trainee is to be provided with a designated travel day on the first day of the new rotation before the start of any clinical activities.
   4. Postgraduate trainees are not to be expected to travel long distances during inclement weather for clinical or other academic assignments. If such weather prevents travel, the trainee is expected to contact the program office promptly. Assignment of an alternate activity is at the discretion of the Program Director.
   5. Postgraduate trainees, when going to or from work or as part of their clinical duties, should assess the environment if walking alone, especially at night.  Trainees are not expected to walk alone through areas they assess to be unsafe.  If required, the trainee should request to be accompanied by the appropriate security service.
   6. It is expected that postgraduate trainees will arrange safe transportation home if they feel unduly fatigued after their duty hours.
   7. Training programs where land or air transport (fixed wing or rotor) forms part of the clinical training must be addressed by that training program’s own safety policy.
2. Relating to patient care
   1. Postgraduate trainees are not to work alone after hours in health care or academic facilities without accessible support from security services.
   2. Postgraduate trainees are not expected to make unaccompanied home visits unless they have had training relevant to the context.
   3. Postgraduate trainees should only telephone patients from a clinic or hospital telephone line. If a call must be made on a personal or mobile device, it should be done using call blocking or some other tool to prevent disclosure of the caller’s information.
   4. Postgraduate trainees are not to assess potentially violent or psychotic patients without the backup of security, and an awareness of accessible exits.
   5. Special training must be provided to postgraduate trainees who are expected to encounter aggressive/violent patients
   6. The physical space requirements, including access to unimpeded exit door, for management of potentially violent patients must be available where appropriate
3. Relating to Facilities
   1. Call rooms and lounges must be clean, smoke-free, located in safe locations, and be equipped with adequate lighting, a functional bed, chair, desk and telephone. Fire alarms and smoke detectors must be in good working order and maintained appropriately. General facilities should also include washrooms and showers.  Appliances supplied are to be in good working order.  Daily linen services and housekeeping for bed-changing and room cleaning should be provided where appropriate. There must be adequate locks on doors to ensure security and privacy.
   2. Site orientations must include a review of local safety procedures.  As with any employee of the institution, postgraduate trainees must be aware of and follow the institution’s policies and procedures, which must be readily available to all trainees.  This includes appropriate Workplace Hazardous Materials Information System (WHMIS) training to understand protocols when in contact with various types of hazardous waste including substances which are
      1. Ignitable
      2. Corrosive
      3. Radioactive
      4. Toxic
      5. Reactive
      6. infectious
   3. Postgraduate trainees are expected to familiarize themselves with the location and services offered by the institution’s Occupational Health and Safety Office. This includes familiarity with policies and procedures for infection control and other protocols following exposure to:
      1. contaminated or other fluids
      2. needle stick injuries
      3. reportable infectious diseases
   4. As well as protocols relating to but limited to the following:
      1. Fire alarms and emergencies
      2. Hospital / Facility Evacuation
      3. Disaster (External AND Internal)
      4. Violent / Behavioural Situation
      5. Bomb Threat or suspicious package
      6. Hazardous Material Spill
      7. Hostage / Active shooter situation
4. Relating to personal care
   1. Postgraduate trainees must observe universal precautions and isolation procedures.
   2. Postgraduate trainees must keep their required immunizations up to date, and report these to the Clinical Placement Risk Management Office without delay. The result in not keeping immunizations current is suspension from training and stoppage of pay.
   3. Overseas travel immunizations and advice should be sought well in advance when traveling abroad for rotations or meeting in accordance with the policies as described by the Faculty of Medicine’s International and Global Health Office.
   4. Postgraduate trainees working in areas of high and/or long-term exposure to toxic substances, including but not limited to chemotherapeutic agents, reagent dyes etc., must follow the institutional safety policies.
   5. Postgraduate trainees working in areas of high and/or long-term exposure to radiation must follow radiation safety policies and minimize their exposure according to current guidelines.  
   6. Radiation protective garments, such as aprons and neck shields, must be available and used as appropriate to the exposure by all postgraduate trainees during fluoroscopic techniques.
   7. Pregnant trainees are expected to be aware of specific risks to themselves and their fetus in the training environment and request accommodations where appropriate.

PSYCHOLOGICAL SAFETY

5. Learning environments must be free from intimidation, harassment, discrimination and violence.
   1. University of Ottawa
   2. University of Ottawa  
   3. University of Ottawa
   4. University of Ottawa
6. All postgraduate trainees have the right to work in an environment that is free from mistreatment and/or exclusion on the basis of any protected grounds as defined by the Ontario Human Rights Act (e.g. age, perceived race, ethnoreligious affiliation, gender identity, disability, sexual orientation, marital/family status).  Principles of equity, diversity and inclusion must be adhered to in order to respect the rights, dignity and full participation of all postgraduate trainees within the Faculty of Medicine.
7. When a postgraduate trainee’s performance is affected or threatened by poor health or psychological conditions, it is expected that the trainee will be granted a leave of absence and receive appropriate support. Such trainees are not to return to work until an appropriate assessor has declared them ready and appropriate are in place, if required.
8. Postgraduate trainees should be aware of and have easy access to the available sources of immediate and long-term help for psychological problems, substance abuse problems, harassment, and inequity issues. Resources include, but are not limited to, the OMA Physician Health Program, Faculty of Medicine Office of Faculty Wellness, 91��Ʒ���ϳԹ� Human Rights Office, the Professional Association of Residents of Ontario and the Employee Assistance Program of the trainee’s home/base hospital (or the Ottawa Hospital as a default for community-based trainees). 

PROFESSIONAL SAFETY

9. As relates to religious accommodations
   1. Postgraduate trainees may experience conflicts between their ethical or religious beliefs and the training requirements and professional obligations of physicians. Resources are to be made available by the program or clinical service to trainees to deal with such conflicts.
   2. Programs must make reasonable accommodations for religious holidays.
10. As relates to Fatigue Risk Management
    1. Postgraduate trainees identified as being excessively fatigued should not be given responsibility of critical tasks or should be asked to relinquish responsibility to someone capable of performing it.  The trainee may be asked to take a break in order to reenergize before returning to duties
    2. Postgraduate trainees self-identifying as excessively fatigued, must inform the appropriate supervisor in order to mitigate potential for unsafe patient care
11. As relates to critical incidents
    1. Postgraduate trainees providing after hours care or consultation must have adequate access to an appropriate supervisor.  As required, this may include the timely attendance of the MRP to assist the trainee.
    2. Postgraduate trainees must have adequate support from the program following an adverse event or critical incident.
    3. Programs must promote a culture of safety in which postgraduate trainees are able to report and discuss adverse events, critical incidents, ‘near misses’, and patient safety concerns without fear of recrimination.
12. As relates to confidentiality
    1. Programs and the PGME Office collect and must responsibly and securely hold confidential postgraduate trainees’ personal information, including health information. Disclosure is appropriate where required for the purposes of facilitating required personal support of the trainee.
    2. Programs must be aware of and comply with the Freedom of Information and Protection of Privacy Act (FIPPA) in relation to postgraduate trainee files.
    3. Postgraduate trainee evaluation information must be handled in a manner that ensures confidentiality unless the trainee explicitly consents otherwise.  Disclosure may be required for the purposes of maintaining patient and workplace safety or in the support of the trainee in difficulty but should be limited to individuals providing ongoing educational guidance where possible.
    4. In the case of a complaint against the trainee that must be dealt with due to its severity of threat to others, or in accordance with Bill 18 (Building Workplaces for a Stronger Economy (2014)), a program director may be obliged to disclose information against the trainee’s wishes.  Depending on the nature of the complaint, the affiliated institution and/or the College of Physicians and Surgeons of Ontario may be involved.  The program director should serve as a resource and an advocate for the postgraduate trainee during this process.
13. As relates to medicolegal protection
    1. Postgraduate trainees must be members of the CMPA and follow CMPA recommendations in the case of real, threatened, or anticipated legal action.
    2. In addition to CMPA coverage for patient actions, trainees are covered, either by the University itself or its insurer, for actions arising from their participation (acting reasonably) in University committees (e.g. tenure, appeals, residency training) on which they may serve.

REVIEW

14.  This Policy will be reviewed 1 year after adoption and every 3 years subsequently.

Policy on Postgraduate Trainees Undertaking International Electives

INTRODUCTION

The benefits to postgraduate medical trainees participating in international clinical electives are recognized by the faculty and the medical literature. However, these electives pose potential risks for the trainee and the receiving community and institution, therefore proper preparation, oversight and follow up are required.

For international electives trainees are required to carry out special preparation, particularly important for those planning to work in low resource settings.

Note: Trainees are responsible for the application and cost of any passport, visa, insurance, health related and other requirements, as appropriate. 

PURPOSE

This policy will outline the requirements for application and successful completion of international elective to receive faculty support and recognition for these activities.

OFFICE RESPONSIBLE

The International and Global Health Office (IGHO), Postgraduate Medical Education (PGME) office and the trainee’s specialty or subspecialty program jointly approve these electives. Trainees are required to comply with instructions from the PGME Office and the IGHO, as well as their respective Programs/Program Directors.

In addition to this policy, trainees must abide by the University of Ottawa’s policy 128 ‘International Travel Safety Policy’.

Section 1: ELIGIBILITY CRITERIA

1. Trainees must have permission from their Program Directors to participate in an international elective.
2. International electives should be a minimum of four weeks in duration.
3. The residency program must grant the trainee academic credit toward their program
4. Trainee requires an international supervisor who must be a practicing physician or researcher (for research electives). The trainee must provide contact information for their supervisor
5. Trainee is in good academic standing, and where applicable, trainee’s work visa and sponsor permit the undertaking of international training

Section 2: APPLICATION PROCESS

Applications for international electives should be submitted to the trainee’s respective program a minimum of four months prior to their placement start date. This will allow the trainee to properly prepare for the elective and allow enough time for required immunizations, visas, passports, and pre- departure training. Once the trainee’s program approves the dates and confirms the trainee is in good academic standing the application is sent to the IGHO for processing trainee to complete “Application Form to request approval for an International Elective” and “Release of Liability Form” available on the IGHO website.

The international elective will be pre-approved by the IGHO if the following requirements are met:

1. The Program Director provides a letter of support signed by both the program director and the site supervisor

NOTE: Trainees must not be supervised by an immediate, extended, or in-law family member.

2. The destination region for the elective does not carry a warning of “Avoid non-essential travel” and/or “Avoid all Travel” on the Global Affairs Canada Travel Advice and Advisories webpage.
   1. Trainee should read the profile of the country and the region within the country that they are traveling to on the .
   2. Trainee to provide appropriate educational objectives, approved by their Program Director.
   3. Trainee to provide all required information requested on the application. Incomplete applications may lead to delays or refusal.

NOTE: Once the elective has been approved, it is possible to revoke this decision and cancel due to changes in conditions in the country, loss of in-country supervisor, OR arising academic or professional concerns on the part of the trainee.

Section 3: PRE-DEPARTURE REQUIREMENTS

1. Trainee must complete pre-departure training as directed by the IGHO.
2. Trainees must complete the “Travel Risk Awareness- Security” course in the Digital Learning platform provided by International SOS.
3. Trainees must register their trip with the .
4. Trainees must register their trip with the .
5. Trainee may be required to take part in post-elective debriefing sessions, as appropriate. The IGHO and Faculty Affairs Wellness are available to trainees wishing to debrief about their experience.
6. Upon completion of the elective, the trainee is required to provide a mobility report. This document is to be forwarded to the IGHO.
7. A formal evaluation of the trainee is required at the end of the elective as per the policy for the . 

Section 4: DURATION AND REMUNERATION

1. International Electives are, ideally, expected to be a minimum of four weeks in length (a rotation). Although there are no routine funds available for elective activities, trainees are encouraged to contact their program to check for available funding.

Section 5: MEDICAL-LEGAL COVERAGE DURING ELECTIVE

1. Trainees are required to to confirm their coverage and to inform CMPA of their planned activities. 

In cases where CMPA coverage doesn’t apply, the University’s Commercial General Liability insurance policy, which includes malpractice, would apply as long as:

1. The trainee is registered as a 91��Ʒ���ϳԹ� trainee during the time of the “work”/placement in question
2. The university has a written placement agreement which covers the trainee’s work prior to the start of the placement, and
3. The trainee receives academic credit (approved by the University) for the time in question when the event causing the loss occurs.

Section 6: ALIGNMENT WITH THE POSTGRADUATE TRAINEE SAFETY POLICY

1. Trainees and Program Directors should note that all the conditions outlined in the  may not be realistically possible to adhere to during an international elective. All steps will be taken to minimize risk for trainees and their host communities.

Section 7: SUMMARY

Trainees must:

1. have their application approved PRIOR to undertaking the international elective. Application must be approved by the Program Director, IGHO and Postgraduate Medical Education Office.
2. complete pre-departure training, as directed by the IGHO.
3. submit the mobility report to the IGHO.
4. complete post-elective debriefing, as directed by the IGHO.
5. complete the evaluation In-Training Evaluation Report (ITER).
6. submit or ensure submittal of evaluation form by supervisor to the Program Director.

POLICY REVIEW

This policy will be reviewed in 1 year after adoption and every 3 years subsequently.

Training Policy

PREAMBLE

The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada are the national bodies that set the Standards for Residency Training for the accredited postgraduate medical training programs for physicians in Canada. It is the responsibility of the Faculty of Medicine Postgraduate Medical Education Committee (PGEC) to oversee residency training programs and the Faculty of Medicine Postgraduate Clinical Fellowship Committee (CFC) to oversee fellowship and Areas of Focused Competence (AFC) training programs at 91��Ʒ���ϳԹ�, and to ensure that standards are maintained.  These committees shall each oversee the occasional modifications in training requirements as requested by any program’s Residency/Fellowship/AFC Training Committee. This policy covers any required modifications that are not applicable to existing general rules and regulations. Any modifications will need to be guided by principles of natural justice and pedagogical soundness. Such decisions will require the consensus of the PGEC or CFC.

POLICY

The Postgraduate Medical Education Committee shall be responsible for approving residency training requirements which are in addition to the specialty training requirements defined by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada where the failure for a resident to meet such enhanced requirements could result in prolonging the period of training.
The Postgraduate Clinical Fellowship Committee shall be responsible for approving Fellowship and AFC training requirements which are requested by either individual training programs or programs under the umbrella of a department which requires the modification.

Process

1. Programs seeking enhanced training requirements need to make application, both in writing and with an in camera presentation to the PGEC or CFC outlining the following:
   1. The nature of the training
   2. The logic for the requirement
   3. The process and timeline for addressing a resident’s failure to meet the training requirements within the stipulated range
2. Approval will be by simple majority of the PGEC or CFC
3. For Residency program modifications, residents will be given at least one year’s notice before any changes are enacted.
4. For Fellowship or AFC program modifications, fellows and AFC trainees will be provided with the changes at the start of their training period.  
    

Waiver of Training After a Leave of Absence Policy

PREAMBLE

The Postgraduate Medical Education Office allows for the possibility of granting a waiver of training after an approved leave of absence for Residents.  Waivers of Training may be applied to residents in both time-based programs and in competency-based training. While the exit from training is based on demonstrated achievement in competency-based training programs, time may still be considered in recognition of the formal agreements the University of Ottawa, PGME holds with the provincial ministry of health and regulatory bodies.

Both the RCPSC and CFPC state that residents must complete all program training requirements.

• To meet the CFPC certification exam eligibility requirements, Family Medicine residents must make up any leaves of absence to ensure the full duration of twenty-four (24) months training is completed. Waivers of training of four (4) weeks may be considered and granted at the discretion of the Program Director only by exception and under unusual circumstances. The CFPC must be notified of the waiver prior to submission of the completion of training notice to the College.
• Where a resident in a RCPSC program will have achieved the required level of competence by the end of the final year of training, a waiver of four to twelve (4-12) weeks may be requested by the Program, to be approved by the Vice-Dean, PGME or designate.

PURPOSE AND BACKGROUND

To provide guidance to program directors and residents on exploring, applying for and granting waivers of training time.

The Vice-Dean, PGME, or designate may grant a waiver of training further to the recommendation of the resident’s program director following the resident’s approved leave of absence in accordance with the policies of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC), provided that the resident meets the criteria for an exceptional resident set out below. A waiver of training cannot be granted in any other circumstances. 

SECTION 1: REQUIRED PROCESS TO REQUEST A WAIVER OF TRAINING

1. Residents who wish to explore whether they may be eligible to have training waived must discuss this with their program director. There may be program-specific guidelines in place, in addition to RCPSC/CFPC requirements and PGME requirements. Residents are entitled to know in advance how their performance will be evaluated to determine whether they qualify for a waiver of training. Residents are not automatically entitled to a waiver of training.
2. A resident can be granted a waiver of training after a leave of absence if they have met all training requirements of the RCPSC/CFPC and all of the program’s educational requirements, and the Program Director is satisfied that the resident will have achieved the required level of competence by the end date of the training. Every program must make information on the educational requirements available to residents.
3. When considering a waiver of training the Program Director must take into account:
   1. any unsatisfactory, borderline or incomplete rotation evaluations
   2. inconsistent attendance at academic activities
   3. changes to training that resulted in an overall dilution of the educational experience
   4. any concerns about the academic, professional, behavioural and ethical performance of the resident
   5. performance in objective evaluations (e.g., OSCE, mini CEX, multiple choice examinations, oral examinations, short answer questions and evaluating examinations)
   6. assurance that all training objectives outlined by the respective college will be met by the end of the training
   7. Work based assessment such as EPAs.
4. The Program Director may recommend a waiver of training up to the maximum allowable times permitted by the RCPSC and CFPC, as noted below:
   1. It is the responsibility of the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) to set maximum allowable times for waivers of training that maintain eligibility for certification.
   2. Maximum allowable times for waivers are as follows:
      1. Family Medicine - four weeks
      2. One-year programs - no waiver allowed
      3. Less than one year for remediation or enhanced skills - no waiver allowed
      4. Two-year programs (excluding Family Medicine) - six weeks
      5. Three-year programs - six weeks
      6. Four-year programs – twelve (12) weeks.
      7. Five-year programs – twelve (12) weeks.
      8. Six-year programs – twelve (12) weeks.
      9. For residents taking subspecialty training in the final year of a specialty program (e.g., Internal Medicine and Pediatrics), up to twelve (12) weeks is allowable in PGY4 only if the program directors in both the specialty and subspecialty programs agree that a waiver can be recommended.
5. In the beginning of the final year of training a resident may make a request in writing to the Program Director.
   1. In time-based training, a decision to grant a waiver of training cannot be granted after the resident has taken the certification examinations.
   2. In CBD programs, as exam eligibility will be determined by the program during the third stage of training, Core of Discipline, requests for waivers can be submitted after the certification exam. In programs where the oral examination is in the last six (6) months of the final year of training, new waiver requests cannot be submitted after the completion of the oral examination.
6. If the program approves the request for the waiver, the Program Director must then submit a letter of support to the Postgraduate Dean. The Program Director’s letter must include the following information:
   1. resident’s name, program, level, dates of the program time leave being waived and the recommended revised end date.
   2. confirmation that the resident has successfully completed all training requirements of the program, including in-training examinations, quality assurance projects, case logs, etc.
7. The Vice-Dean, PGME, or designate reviews the request, and if approved, the PGME Registration Coordination will update the Confirmation of Completion of Training (CCT) and forwards it to the Royal College or the College of Family Physicians. 

If approved, the program must submit a advising the resident’s new end date.

SECTION 2: APPEALS

A decision not to grant a waiver of training cannot be appealed.

SECTION 3: LINKS TO RELEVANT POLICIES

SECTION 4: DEFINITION OF AN EXCEPTIONAL RESIDENT

Minimum criteria for the purposes of a waiver of training

NOTE: Each program can add its own criteria to define “exceptional” within the context of their specific program.

Decision responsibility

• Program Director, based on the Residency Program Committee recommendation.
• Vice-Dean, PGME or designate approves decision.

Criteria

• Must be subsequent to the first on-service year (with the exception of family medicine):
  • objective assessments (e.g., OSCE, mini CEX, multiple choice exams, oral examinations, short answer questions)
    • must pass all exams.
    • must be above “meets expectations” at least 75% of the time.
  • ITERs or ITARs – “meets expectations” or above at least 75% of the time on all evaluations.
• No concerns re: the resident’s academic, professional, behavioral and ethical performance;
• Have successfully completed all stages of training per the requirements of the accrediting body [for CBD programs]
• No red or yellow zone behaviours on the PULSE 360° Survey System.
• Consistent attendance at academic activities.
• Includes tangible contribution to department, including in at least one of the following areas:
  • administration (e.g., chief resident, RPC rep, PARO rep);
  • research (e.g., published papers or presented posters during residency);
  • education (e.g. resident teaching awards, consistent excellent teaching evaluations).
• None of the following (each below is an exclusion criterion)
  • extra educational activities as defined in the evaluation policy of PGME (formal or informal).
  • remediation (formal or informal).
  • probation.
  • suspension.
  • interruption in residency training exceeding twelve (12) months.
  • failed rotations.
• “Early consultant level competency”
  • is prepared to challenge the certification exam at the same time as their cohort of residents, despite the decrease in training time.
  • at the time the waiver is granted, would be capable of transitioning into independent practice or advanced clinical training.

Wellness Policy

 
STATEMENT

This policy reflects the University of Ottawa (91��Ʒ���ϳԹ�), Faculty of Medicine’s commitment to a safe, positive, and healthy learning environment for all Postgraduate Medical Education (PGME) trainees by creating, promoting, and sustaining a culture of wellness and resilience within the environment.

The Faculty Wellness Program (FWP) at the Faculty of Medicine offers and supports wellness-related programs that assist PGME trainees in optimizing their physical, mental, and emotional well-being.The FWP also assists clinical department programs to develop and sustain a positive learning environment to optimize learning, morale, and attainment of career goals.

WHO IS AFFECTED BY THIS POLICY?

This policy applies to all trainees (residents and fellows) in PGME at 91��Ʒ���ϳԹ�. Faculty involved in the education of PGME trainees are also supported under this policy to provide the appropriate structure for safety and wellness.

FACULTY WELLNESS PROGRAM

The FWP promotes and supports a culture of physician health and wellness to sustain a solid foundation in professionalism and patient care.  A distinct part of the FWP mandate includes providing PGME trainees with a safe and confidential venue to seek out resources that protect and enhance their health and well-being.

Here, PGME trainees can discuss concerns about personal, academic, or work-related matters freely. No members of the FWP team, including the Assistant Dean FWP and the Director of Learner Wellness, play a role in the evaluation of the trainee. Therefore, discussions about concerns remain at arm’s length from Program Director, or other faculty who are involved in the evaluation of the trainee.

WELLNESS SUPPORT

The FWP team provides support in the following areas:

• Educational sessions (i.e.: workshops, training, facilitated discussions) on wellness topics shaped to suit the needs of groups, programs, or departments
• Individual counselling
• Accommodations
• Resident wellness needs (individual or group) for PDs
• Support for development and implementation of wellness topics within a program’s curriculum
• Referrals to health care providers, counsellors, coaches, and the Ontario Medical Association Physician Health Program
• Administration of the Resident Wellness Committee

FWP Team:

• 1  Assistant Dean, Faculty Wellness Program
• 1  Director of Learner Wellness, Faculty Wellness Program
• 2  Clinical counselors
• 1  Program Manager
• 1  Program Officer

Counselors of the FWP team belong to a professional order and are bound by a strict code of ethics.This includes adherence to rules of confidentiality and conflict of interest.They offer short counselling term (typically 8-12 sessions) to PGME trainees and can accommodate daytime or evening appointments (Monday to Friday) for one-on-one wellness support.   Additionally, counselors facilitate support groups and workshops designed to enhance resident resilience and well-being.   Counseling services are offered either in person or virtually via a secure platform.

The FWP works with PGME programs and trainees to support peer-led wellness initiatives to further strengthen trainee well-being and enhance the environment of their respective programs.

The Faculty Wellness Program can be contacted by calling 613-562-5211 or by emailing [email protected].

CONFIDENTIALITY

Information is collected and stored in accordance with the University of Ottawa’s Policy 90 – Access to Information and Protection of Privacy

• Client electronic files are confidential and kept securely – according to PHIPA rules. Files are kept for a period of 10 years after which time they are deleted.
• Files are password-protected.
• Client information can only be released with their written consent.
• Access to confidential clinical notes of our client files is restricted to the clinical counsellor(s).
• Confidential administrative documents are managed by authorized FWP personnel only.  

CONFLICT OF INTEREST

In cases where a FWP physician must provide medical care to a trainee, and where there is also an academic relationship, the trainee is advised that they have the right to ensure that the FWP physician recuses him/herself from all subsequent trainee evaluations. The trainee is encouraged to request a change in supervisor or teaching site when this conflict exists. Alternatively, the trainee can still be taught by this FWP physician, as long as there is an explicit understanding that they do not partake in the trainee’s evaluation process. 

RESIDENT WELLNESS ADVISORY COMMITTEE:

The Resident Wellness Committee (RWC) acts as an advisor in providing strategic direction to the PGME office and the FWP in areas of wellness supports.

The RWC will assist in identifying, goals, and implementation strategies to encourage healthy behaviours in the learning environment.The RWC will promote the development of physician health awareness and expertise within PGME programs, while advocating for policy changes aimed at bettering resident physician wellness.

University of Ottawa, Faculty of Medicine, Resident Wellness Committee term of reference

ACCOMMODATION POLICY

The 91��Ʒ���ϳԹ� Faculty of Medicine, PGME program is committed to ensuring that appropriate accommodations are provided for PGME trainees with disabilities where possible.  The purpose is to create barrier-free learning environments by providing supports and services in accordance with Human Rights obligations and aligned with the 91��Ʒ���ϳԹ� principles for accommodations.

Accommodation is a shared responsibility. It is most effectively provided when those involved approach the process with fairness, sensitivity, respect for confidentiality and co-operation. This requires the exchange of relevant information between the appropriate parties, and a constructive discussion about the appropriate accommodation in the circumstances. Accommodations support diversity in the workplace and learning environment. They create a fair and level training environment for all trainees to thrive in.

A PGME Accommodation Policy outlines the process for accommodations including the role for an Accommodation Planning Committee (PGME APC) which is formed when necessary to develop, monitor and revise accommodation planning for UOttawa PGME trainees.

Postgraduate Medical Education (PGME) Policy and Procedures for Accommodation of Postgraduate trainees with Disabilities

PGME Accommodation Planning Committee (APC) terms of reference  

RESPONSIBILITIES OF PGME TRAINEES AND PROGRAMS

PGME trainee responsibilities

• Work towards an appropriate work-life balance.
• Understand own limitations relating to fatigue, stress, emotional or physical difficulties and other issues with self-care on capacity to work and train.
• Understand hazards of alcohol or chemical dependency on personal health and capacity to work and train.
• Be aware of colleagues who may be having difficulty and respond as able and necessary.Recognize and inform the PD or other faculty regarding individual or broader wellness issues in the learning environment.
• Be familiar with the available Wellness supports and resources.
• Be aware of PGME policies and processes that support wellness, including those related to Accommodation, Professionalism and Intimidation and Harassment.
• Access and utilize appropriate available resources to seek care – including (but not exclusive to) health/psychological counselling, FWP resources, primary care physician.
• Communicate safety issues in the learning environment to the Program Director in a timely manner.Appropriate safety concerns may include (but not exclusive to) after hours work, fatigue risk management, exposure to hazardous materials/infectious agents/ionizing radiation, safe disclosure of patient safety, violence in the workplace, etc.
• Communicate incidents of intimidation or harassment in the learning environment to the Program Director, other Faculty, or submit the Faculty of Medicine professionalism in a timely manner.
• Identify own requirement for accommodation when appropriate, as consistent with PGME Accommodation Policy. 

Training program responsibility

• Physical and emotional health concerns of all trainees are prioritized, recognized and addressed
• Establish a culture of wellness support and health promotion within the program and in the learning environment
• Ensure there is a strategy for fatigue risk management within the program
• Maintain zero tolerance of intimidation and harassment within the program and the learning environment
• Ensure trainees are familiar with and have access to the policies, reporting mechanisms and supports required for incidences where there is a breach of safety or professionalism
• Maintain confidentiality and discretion for all trainees
• Enable multiple points of entry for trainees to discuss wellness/safety issues
• Enable a non-judgmental program and learning environment
• Enable access to wellness/safety support through resources within the structure of the following organizations: 91��Ʒ���ϳԹ� Faculty of Medicine, Hospital (occupational health), resident regulating bodies (e.g., PARO, RDocs), community and regional bodies (e.g., OMA, primary care physician)
• Provide career advice/counselling and support transitions where needed to ensure appropriate development of future training or practice opportunities

FATIGUE RISK MANAGEMENT (FRM)

PGME trainees have a professional responsibility to appear for duty appropriately rested and must manage their time before, during and after clinical assignments to prevent excessive fatigue.Trainees are responsible for assessing and recognizing the signs of impairment including that which is due to illness and/or fatigue in themselves.Trainees experiencing such impairment are to notify their Program Director or designate.

PGME and programs offer educational resources and information on fatigue prevention, mitigation and recognition strategies for trainees and healthcare providers. FRM curriculum and safety policies should be incorporated in all programs.Established pathways to identify and proactively prevent fatigue-related incidents should be included in the program’s process of quality assurance in the learning environment.

Within that shared responsibility, trainees have a key role in managing and reporting their own fatigue to their supervisors, peers and to the healthcare team. To support this, medical education leaders are accountable for ensuring practices are in place that enable and protect every trainee's ability to fulfill their role in the management of fatigue risk.

A module on Fatigue Risk Management is available to trainees on Brightspace.

COMPLAINT MANAGEMENT

All members of the University community have a right to a learning and workplace environment that is respectful, safe, healthy, and free from harassment and discrimination pursuant to the University of Ottawa Policy 67a – Prevention of Harassment and Discrimination.

PGME trainees are encouraged to submit reports of incidents of mistreatment via the Professionalism Office , or privately and confidentially to the Vice Dean PGME, or Assistant Dean, PGME.  Incidents of sexual harassment and or sexual violence are deferred and managed by the 91��Ʒ���ϳԹ� Human Rights Office (HRO) as per Policy 67b Prevention of Sexual Violence.

All levels of learners (Undergraduate, Postgraduate, Graduate, TMM, Post Doc Fellow, Clinical Fellow), and Faculty Members have a duty to adhere to the 91��Ʒ���ϳԹ� Faculty of Medicine’s Policy on Professionalism in all clinical, academic and research settings.  This includes all interactions whether in person, in writing or by electronic means (for example, email, social media, internet).

The University of Ottawa and the Faculty of Medicine reaffirms its ongoing commitment to providing, promoting, and maintaining a professional and respectful working and learning environment.

Our goal is the create and sustain a culture of equity, diversity, inclusion and belonging for all members of the Faculty of Medicine community.  All Faculty members have the right to work in an environment that is free from mistreatment and/or exclusion on the basis of any protected grounds as defined by the Ontario Human Rights Act (e.g. age, perceived race, ethnoreligious affiliation, gender identity, disability, sexual orientation, marital/family status).  Principles of equity, diversity and inclusion must be adhered to in order to respect the rights, dignity and full participation of all PGME trainees, staff and faculty within the Faculty of Medicine.